Second Child Apparently Cured of HIV Has Virus Reappear

Virus was undetectable for 3 years before researchers discovered viral reservoirs have not disappeared.

Virus was undetectable for 3 years before researchers discovered viral reservoirs have not disappeared.

On the heels of an announcement earlier this year involving a young child who was clear of HIV 2 years after ceasing treatment before detectable levels of the virus were found again, researchers in Italy have reported a similar occurrence.

In a case report published October 1, 2014 in The Lancet, a baby born to an HIV-positive mother in 2009 was apparently cured of the virus at 3 years of age following intensive ART treatment that began shortly after birth. Not only did the child’s viral load suggest HIV had been eradicated, but antibodies to the virus disappeared, which indicates the baby was no longer seropositive.

As a result, the child’s mother agreed to cease ART treatment.

Just 2 weeks after stopping treatment, the child’s HIV tests came back positive again. Subsequently, researchers determined the viral reservoirs had not been eliminated by ART, despite being undetectable for more than 3 years.

In a highly publicized case earlier this year, a child known as the “Mississippi baby” experienced a similar viral resurgence after appearing to be cured. The 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 infant 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 infant 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. However, it was announced on July 10, 2014, the child again had detectable levels of HIV in the blood (16,750 copies/mL).

An additional viral load blood test 72 hours confirmed the finding (10,564 copies/mL of virus). The child has since resumed antiretroviral therapy and is tolerating the treatment with decreasing viral levels and no side effects, according to the National Institute of Allergy and Infectious Diseases.

Unlike the Mississippi baby, however, the Italian child’s immune system exhibited multiple signs of responding to HIV infection after the viral load became undetectable. Italian researchers suggest that a high viral load at birth and low birthweight, in addition to being infected in the womb, may have negatively impacted the length of the viral remission.

“The availability of many classes of potent antiretroviral drugs has substantially decreased HIV morbidity and mortality, but these drugs cannot eradicate the virus because they do not eliminate viral reservoirs,” the study authors wrote. “The search for an HIV cure continues.”