A cure for newborns?
Canadian scientists have published new information that’s relevant to the search for a cure in newborn babies who are HIV positive.
In 2013, the case of the so-called “Mississippi Baby” was reported. The infant’s mother was HIV positive, but had not received any HIV care before she gave birth. The baby began HIV treatment 30 hours after birth and took it for 18 months, before the mother and child dropped out of care and stopped receiving treatment. They came back to medical care when the baby was almost two years old and – to everyone’s astonishment – HIV could not be detected in the infant’s body.
This case raised hopes of a ‘functional cure’ for HIV – in other words, HIV not replicating even when anti-HIV drugs are not taken.
Canadian doctors have now examined their records and found a handful of cases with some similarities.
One reason that the cases are so rare is that when the right HIV care is provided to pregnant women who are living with HIV, this stops HIV from being passed on. The babies are born without HIV and no ‘cure’ is needed.
Nonetheless, women are sometimes diagnosed very late in pregnancy or have had problems taking their HIV medication regularly. In cases like these, Canadian doctors give the baby HIV treatment as soon as possible after birth.
They identified 136 cases like this. For most of them, there was no evidence that the baby had ever had HIV.
But twelve infants had evidence of HIV infection. For eight of them, the early treatment did not work – probably because they were not given their treatment regularly.
But there were four babies who took treatment and who achieved sustained virological suppression. For several years after birth, multiple tests used to detect HIV infection have had very encouraging results – no signs of HIV antibodies, undetectable viral load with an ultra-sensitive test and no detectable HIV DNA. However, extremely low levels of virus capable of replicating have been found.
The results certainly show that in these four children, HIV has been suppressed to extremely low levels. The ‘reservoir’ of HIV-infected cells in peripheral blood is far smaller than it would otherwise be.
But we don’t know whether HIV has been eradicated or whether this amounts to a functional cure. We don’t know whether the children still need HIV treatment.
The only way to find out would be for them to stop taking treatment and to monitor their test results. But the Canadian doctors think that this is quite a risky strategy that shouldn’t be undertaken lightly.
However, American researchers have announced that they plan to test that approach. They are launching a global study which will offer immediate HIV treatment to babies born with HIV. The treatment will be stopped after around two years and results monitored.
And it’s worth remembering that we already know how to prevent HIV being passed on from mother to child – prompt diagnosis of HIV, taking anti-HIV drugs during pregnancy and avoidance of breastfeeding. Thanks to these safety measures, 99.5% of babies born to women living with HIV in the UK do not have HIV.
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