Early Treatment Clears Virus in Second HIV-Infected Baby

A child born infected with HIV in California began treatment hours after birth, and is clear of virus 9 months later. Just one year after the landmark announcement that a baby in Mississippi had been functionally cured of HIV due to aggressive antiretroviral therapy started within hours after birth, researchers have announced that a second baby is also clear of the virus following early treatment. On March 5, a team of researchers announced at the annual Conference on Retroviruses and Opportunistic Infections that a child born 9 months ago in Long Beach, California, was cleared of the virus after beginning Combination Antiretroviral Treatment (cART) just 4 hours after being born. While many expressed doubt that the baby born in Mississippi ever actually had the virus, there was clear evidence that the second child had HIV. “In a second infant, cART by four hours of life led to rapid clearance of replicating virus and an undetectable proviral DNA by clinical assays within 6 days of life, supporting restriction of HIV spread with very early cART,” researchers wrote in the case abstract. Researchers also announced at the conference that the Mississippi child, now 3 years old, remains free of the virus despite having being off of treatment for 21 months. The Mississippi child was born prematurely in July 2010 to a mother who had not seen a doctor during her pregnancy and was unaware she was infected with HIV. Her baby reportedly tested positive for the virus at 30 hours of age. Soon thereafter, the child began antiretroviral therapy with 3 drugs: zidovudine, lamivudine, and nevirapine, as opposed to the standard prophylactic treatment. One week after birth, the baby was discharged from the hospital and placed on antiretroviral therapy that included zidovudine, lamivudine, and co-formulated lopinavir-ritonavir. Treatment of the child ceased at the age of 18 months for undisclosed reasons. When the child returned for further evaluation 5 months later, doctors anticipated finding high levels of the virus but instead found it to be nonexistent on standard tests. The child was later found to be free of the virus on standard HIV tests at the ages of 24, 26, 28, and 30 months, even without continuing antiretroviral therapy. In the newly reported California case, the child’s mentally ill mother has advanced AIDS and failed to take the drugs prescribed to protect her baby during pregnancy, according to a report in the New York Times. The baby, who is now in foster care, is not considered “cured” because the child is still on medication, according to the Times. A clinical trial will soon begin in which approximately 60 babies born infected with HIV will begin drug treatment within 2 days of birth and will be tracked for several years, the Times report stated. The results could ultimately help establish a new treatment protocol for children born infected with HIV in the future. “Development of sensitive laboratory markers and standardized approaches will be necessary to guide the optimal management of very early HIV treated infants in order to achieve remission,” the researchers wrote in their abstract.