Tracking the New Buzz Around the HIV Cure

by Shaun Knittel
Saturday Mar 23, 2013

On March 3, amfAR, The Foundation for AIDS Research, described the first documented case of a child being cured of HIV. The news shocked the world. Dr. Deborah Persaud of Johns Hopkins University detailed the case of a two-year-old child in Mississippi diagnosed with HIV at birth and immediately put on antiretroviral therapy.

According to amfAR, at 18 months, the child ceased taking antiretrovirals and was lost to follow-up. When brought back into care at 23 months, despite being off treatment for five months, the child was found to have an undetectable viral load. A battery of subsequent highly sensitive tests confirmed the absence of HIV.

"The child’s pediatrician in Mississippi was aware of the work we were doing, and quickly notified our team as soon as this young patient’s case came to her attention," said Dr. Rowena Johnston, amfAR vice president and director of research. "Because the collaboratory was already in place, the researchers were able to mobilize immediately and perform the tests necessary to determine if this was in fact a case of a child being cured."

According to the Associated Press, the HIV treatment was given to the baby before she was confirmed infected with HIV. And Dr. Mark Siedner, a postdoctoral fellow in the division of infectious diseases at Massachusetts General Hospital and Harvard Medical School, said the question still remains as to whether the child was infected with HIV upon birth, or merely exposed.

"In the case of the Mississippi baby, we know she was exposed to HIV, had HIV in her blood, and that at least some cells in her blood were found with sleeping virus -- though we will likely never know if those cells were from the child or maternal cells that had been transmitted during pregnancy or birth," Dr. Siedner wrote in an opinion piece in the Wall Street Journal. "Was the baby infected with HIV and, thus, cured? It seems more likely that her treatment prevented her, after exposure to HIV, from being infected."

But Dr. Persaud argued that comprehensive tests have confirmed beyond doubt that both mother and child were HIV-positive when the child was born, and today no signs of HIV infection in the child can be detected by the most sensitive means available.

"Given that this cure appears to have been achieved by antiretroviral therapy alone," said Dr. Johnston, "it is also imperative that we learn more about a newborn’s immune system, how it differs from an adult’s, and what factors made it possible for the child to be cured."

The Mississippi case is important for two reasons. On one hand, it underscores the importance of identifying HIV-positive pregnant women, expanding access to treatment regimens that can prevent mother-to-child transmission, and of immediately putting infants on antiretroviral therapy in the event that they are born HIV positive. On the other hand, it points to the possibility that different populations of HIV-positive people might be cured in different ways.

The First Cure: Timothy Ray Brown, The Berlin Patient

Outside of the Mississippi case, the only other documented case of an HIV cure to date remains that of Timothy Ray Brown, the so-called "Berlin patient."

In 2006, while on treatment for HIV, Brown was diagnosed with leukemia. His physician was able to treat his leukemia with a stem-cell transplant from a person who was born with a genetic mutation causing immunity to HIV infection. Following the transplant, Brown was able to stop HIV treatment without experiencing a return of his HIV disease.

Many hailed Brown as a "medical miracle." But others asked the question, "How else can HIV be cured?"

Scientists are making progress on several fronts in the search for a cure for HIV infections. Promising tactics range from flushing hidden HIV from cells to changing out a person’s own immune system cells, making them resistant to HIV and then putting them back into the patient’s body.

A major stumbling block is the fact that HIV lies low in pools or reservoirs of latent infection that even powerful drugs cannot reach, scientists told the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington. The conference is one of the world’s largest scientific meetings on HIV/AIDS.

Still, scientists report that advances in molecular engineering are allowing researchers to delve more deeply into the mechanism of HIV.


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