Baby Still "Cured" of HIV

An HIV-infected baby treated aggressively with antiretroviral therapy starting shortly after birth remains virus-free at the age of 3 years despite having ceased treatment at the age of 18 months.

An HIV-infected baby treated aggressively with antiretroviral therapy starting shortly after birth remains virus-free at the age of 3 years despite having ceased treatment at the age of 18 months.

In March 2013, a team of researchers reported the case of a baby who appeared to be cured of HIV. According to a case update published in the November 7, 2013, edition of the New England Journal of Medicine, the child is still HIV-free at 3 years of age.

The baby was born at 35 weeks gestation in Mississippi in July 2010 to a mother who had not received care during her pregnancy and who did not know she was infected with HIV. Rapid HIV testing during labor, however, indicated that the mother was infected and, because the infant was at high risk for contracting the infection in utero, antiretroviral therapy was started just 30 hours after birth. The child was given a regimen of 3 drugs including zidovudine, lamivudine, and nevirapine. The baby was diagnosed with HIV based on 2 separate blood samples and continued to receive antiretroviral therapy. After 1 week, the infant was discharged and began receiving treatment with zidovudine, lamivudine, and co-formulated lopinavir-ritonavir.

Tests revealed that the baby’s plasma viral load began to steadily decline 6 days after birth, as is normally seen in infants and adults on antiretroviral therapy, and after 29 days, the infection was undetectable. The child continued to receive the drugs until she was 18 months old—the last time the mother reported filling the prescription. The child did not visit the clinic again for 5 months, and surprisingly, when she returned, the virus was still undetectable. The child continued to test negative for the infection on standard HIV tests at the ages of 24, 26, 28, and 30 months, even though she was not put back on antiretroviral therapy. Ultrasensitive tests did reveal small traces of the virus at the age of 24 months, but they were not present when the test was repeated 2 months later. The researchers believe the first ultrasensitive test may have given false positive results or that the infected cells picked up by the test were unable to replicate.

In an accompanying editorial, however, Scott M. Hammer, MD, urges caution before claiming that the child has been cured of the virus. He writes that long-term follow-up is needed to monitor virus levels in the child as she ages without receiving antiretroviral therapy. He also notes that the case may be unique, and may not necessarily indicate that early, aggressive treatment will cure HIV in other infants. However, he acknowledges that the case is a promising start.

“[W]e are at the stage at which individual case reports can provide proofs of principle, stimulate hypotheses, and lead to carefully designed experimental therapeutic studies involving both adults and children that, we hope, will lead us down the road to the reduction or eradication of the HIV-1 reservoir,” Dr. Hammer writes.