HIV in infants cured

[winner]

With the modern drugs it is very unlikely that the child is infected in the womb. Here though it looks like you are right. Mother didn't know she was positive and so didn't get the drugs. Infant also had higher than expected viral load.

Foolish of the mother to not get tested.



The article clearly states that they believe they have eliminated the virus by preventing it from forming viral reservoirs. That is what ARVs do already. What we really should be asking is why hadn't the virus formed viral reservoirs already if the child was infected in the womb early on in the pregnancy?

If the child wasn't infected early on and instead was infected in the later stages of the pregnancy then again I'm not exactly shocked, this is what ARVs do, they act as a prophylaxis when taken after the initial contact with HIV.

Not every fetus gets infected even without ARVs. what you are saying is exactly what i was asking. if they started ARV therapy within 30hours, then that doesnt qualify as cure if the infection happened during delivery. there are a whole lot of things that can explain the recent HIV negative status and cure is one of the least likely IMO

 

[HavocXphere]

How's it promising though? Chances are good that infant will be an orphan

Not really. For SA its better to have a healthy baby rather than a sick one that the medical system will have to carry for 50+ years. ARVs are not expensive...they are only affordable because they are subsidized like mad.

This looks to me like claiming you were cured of HIV when you get infected through a needlestick injury but you take ARVs and they destroy the virus before it can infiltrate your system fully.

Umbilical cord...the child is exposed to infected blood for ~9 months already. Hardly the same as a needlestick injury in a healthy adult that is treated within hours.

It's also not cured, as there are still traces of the virus left. It just appears to be dormant. Similar to a cancer patient in remission.

...

It is exciting exactly because it appears to have stopped such dormant infection from taking hold.

"Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place," Persaud said.

That's awesome news!

That's awesome/encouraging news!

 

[Azbubu]

AIDS experts cautioned Monday against hype of a cure after doctors in the United States suppressed HIV in a child born with the virus by administering a potent drug cocktail shortly after birth.

The possible breakthrough may hold promise for about 330,000 children the World Health Organisation (WHO) says are born every year with the virus that causes AIDS.

While cautiously optimistic, experts stressed that much remained unclear -- including whether this may have been a freak result.
"The world needs to see this as a proof of concept, but we are not anywhere near implementation" of similar treatment for all newborns at risk, said Harry Moultrie, a paediatric HIV researcher at the University of the Witwatersrand in South Africa, which has a high share of infants born HIV-positive.

"One case does not make an intervention that you can just roll out," said Moultrie, even as he hailed the result "a compelling description of a cure".

Researchers from the Johns Hopkins Children's Center in Baltimore, Maryland, earlier reported they had cured a baby born with HIV.
This was a "functional cure" rather than a full one, as traces of the virus were still present in the child's cells, but at non-dangerous levels.

The baby girl was given a cocktail of three anti-AIDS drugs within 30 hours of being born.

Normally, babies born to HIV-positive women are given a lower, preventative dose of drugs for several weeks, after which full treatment starts upon HIV diagnosis.
In this case, the child remained on antiviral treatment for 18 months. Ten months after treatment was stopped, no HIV was detectable in her blood with standard tests.

"They (the researchers) need to keep a close eye on this child to check that the HIV isn't going to reassert itself further down the line," said Genevieve Edwards of the Terrence Higgins Trust, a UK-based AIDS charity.

She warned the girl may be one among a handful of people whose immune systems don't need drugs to keep the virus from replicating.

Moultrie added it remained to be seen whether the treatment would work on all strains of the virus.

"This was one child and we are not sure of the generalisability or reproducibility of the result," he told AFP.

"If we give the same intervention to 100 children we do not know what proportion of them will give the same result; it may be five percent, it may be 80 percent."

UNAIDS welcomed the development which "gives us great hope that a cure for HIV in children is possible and could bring us one step closer to an AIDS-free generation."

But it cautioned that more study was needed.

"The important thing to concentrate on is to prevent children getting HIV in the first place," said Oxford University AIDS researcher John Frater.

This is best done through screening pregnant women and putting those with HIV on antiviral treatment to prevent transmission.
Frater stressed that parents must not interpret the news as meaning they can take their children off AIDS drugs.

"It is important not to extrapolate from one single case to others. Plenty of children who would stop therapy would rebound."
If confirmed, however, the American research would be a massive breakthrough in the fight against a disease that has claimed some 35 million lives.

"Up until two or three years ago, the general scientific belief was that a cure for HIV was impossible: that we shouldn't research it or invest in it," said Frater.

"Cases like this tell us that a cure for HIV is not impossible... that this is an area of research that we should concentrate on."
WHO statistics show that the bulk, 299,000, of children born with HIV were in sub-Saharan Africa -- about a tenth of them in South Africa in 2011.

 

[RiaX]

Hmmm mother's blood and child's blood do not mix in the womb, its near impossible for a baby to get HIV positive in utero. Ive never seen it in practice. The transmission occurs during birth where the baby is exposed to the mother's blood. Usually we use nevirapine only in the new born child and it works similarly as that of a needle stick injury. Once you are HIV positive you are HIV positive (given that false positives are eliminated). Ive seen viral loads reaching near zero before in adults but it always reoccurs with time.

What ive never seen is a definite positive go to a definite negative, ive heard of viral resistance and an inability to get infected due to mutations of the glycoproteins on the cell membrane of the CD4 cells. Though Im also not convinced by this article and report as there could be many possible reasons its still a fascinating result. Perhaps the virus simply couldnt attach itself to the host immune system and replicate or maybe the therapy induced a form of pH change killing of the virus as its quite fragile and sensitive to pH or perhaps the child has this mutated gene resulting in a polymorph of the GPs on the CD4 cells.

anyways this is the guidelines we use in south africa for PMTCT (prevention of mother to child transmission)

http://www.fidssa.co.za/images/PMTCT_Guidelines.pdf

 

[Space_Chief]

Conference webcast for whoever is interested:
http://webcasts.retroconference.org/console/player/19411?mediaType=podiumVideo

Abstract for the curious:
http://www.retroconference.org/2013b/Abstracts/47897.htm

 

[zippy]

Infant not infants.

It's also not cured, as there are still traces of the virus left. It just appears to be dormant. Similar to a cancer patient in remission.

According to the article they cant find any trace of the virus.

Gay assumed that the virus had resurfaced and began replicating again without the medication to suppress it. She said she was shocked when tests came back showing the baby was HIV negative. She assumed it must be an error and did more tests that continued coming back with no signs of the virus.

That’s when she contacted researchers at the University of Massachusetts and Johns Hopkins Children’s Center to conduct a more sensitive analysis. Those researchers also were unable to find any trace of the virus, prompting them to determine the baby had essentially been cured.

 

[Space_Chief]

According to the article they cant find any trace of the virus.

At age 26 months HIV DNA was detected at 4 copies/million PBMC but with no 2-LTR circles. Plasma viral load, PBMC DNA, and HIV-specific antibodies remained undetectable with standard clinical assays, confirming a state of functional HIV cure.

See my post.

In other words, when they looked at peripheral blood mononuclear cells - a type of white blood cell - they found viral RNA (in the form of DNA) inside the cellular genome using very ultrasensitive methods. But it's hoped that this will not lead to replication. Time will only tell. (Not all viral DNA inserted into cellular DNA is capable of replication, some of it is defective, while other simply does not get copied for unclear reasons.) It's possible there could be latent virus reservoirs in other tissues which have yet to "wake up". So as said, time will tell, if this functional cure lasts. Regardless it's exciting because like the Berlin patient, this opens up new paradigms of treating the infection and makes people excited which drives funding and research.

 

[thedutchman]

great.. more orphans to care for.

 

[Space_Chief]

great.. more orphans to care for.

This type of approach can also be translated into treating Hepatitis B, C, Ebstein Barr and even HTLV infections. So not just HIV and also viruses which can lead to cancer. And HIV treatment allows people to live indefinitely these days, as long as they are conscientious about their treatment (and lucky).