Baby "Cured" of HIV Infection
Eric S. Daar, MD
Eric S. Daar, MD
Dr. Daar received his undergraduate degree from UCLA and medical degree from Georgetown University School of Medicine. He completed an internship and residency in internal medicine at Cedars-Sinai Medical Center and his clinical and research fellowship in infectious diseases at Cedars-Sinai Medical Center and UCLA.
How sure are we, and what does this mean for the future?
Several weeks ago many heard the report in the lay press of a baby born in Mississippi being cured of human immunodeficiency virus (HIV) infection. Although the media buzz was mostly about the drama, less attention was given to what actually happened and the controversy that followed.
What do we know about this case?
It is clear that there was a baby born to a woman who was not aware that she was infected with HIV until she went into labor; rapid HIV antibody testing detected the infection. It was ultimately confirmed that she was infected and actually had relatively low amounts of HIV circulating in her blood. When maternal infection is diagnosed during pregnancy, the woman is routinely started on combination antiretroviral therapy with a marked reduction in the risk of transmitting HIV to the newborn. In this case, the diagnosis was made late, and the mother was not able to be treated, with the focus shifting to the baby who was given a combination of therapy typically reserved for those already known to be infected, as opposed to an abbreviated regimen given primarily for prophylaxis to prevent rather than actually treat infection. The baby was confirmed to be infected based upon the standard definition of having detectable viral DNA or RNA from two separate blood samples and was continued on a treatment regimen with the viral load being repeatedly positive over the first several weeks of life, until being undetectable after approximately three weeks. After being followed for months, the child was lost to follow-up until returning to the clinic off medications for months. In anticipation of restarting therapy, a repeat viral load turned out to be negative. This prompted a more intensive investigation that demonstrated no detectable plasma HIV RNA, cellular DNA, HIV-specific immune responses, or even HIV antibodies by standard assay, leading the investigators to conclude that the child had achieved at the very least a "functional cure."