Baby cured of HIV: What’s the real story?

As undoubtedly you’ve heard by now, there’s another person cured of HIV out there — this time, it’s a baby born to an HIV-infected mother.

Here’s the story: The mother didn’t know she was HIV positive until delivery, and the baby was found to be infected by both HIV DNA and RNA right at birth. The doctors started combination antiretroviral therapy approximately one day later, essentially as soon as the results came back. There was a good response to treatment, with declining HIV viral loads over the next few weeks that quickly became undetectable.

Successful treatment continued for 18 months, at which time mom and baby were lost to follow-up; the mom stopped the baby’s antiretrovirals. When the two returned to care 5 months later, the baby’s HIV RNA and antibody were both negative — much to the surprise of the doctors. Supplemental testing, using evaluations similar to those done on the Berlin patient, did not yield any evidence of replication-competent virus, and the baby remains off therapy today.

In short, baby cured of HIV.  Stop the presses! (Do they still say that?)  Front page story, New York Times. Look at this Google News Page. My colleagues and I are all getting e-mails from our friends/family/etc. asking about this “breakthrough.”

And we’re kind of baffled. Because this case will have about as much immediate impact on the HIV epidemic in the United States as the prior cure — that’s right, virtually none. Maybe it will have an impact globally, but that will be a major challenge.

Thinking about it more, however, I understand why this is such compelling news:

  • It’s a baby. The media love stories about HIV in babies. The whole “innocent victim” thing is hard to shake.
  • It’s a cure. Can’t miss that. And the press is probably hypersensitive about not missing out, since they initially whiffed on reporting the last HIV cure. It was first presented at CROI in 2008 and barely got a peep. Took a resuscitation of the story by the Wall Street Journal and, ultimately, publication in the New England Journal of Medicine for the case to receive major media attention. For the record, rumor has it that a certain highly prestigious medical journal (hint) also initially whiffed on it, rejecting the case report when it was first submitted.
  • The public probably doesn’t really understand that HIV in babies is all but 100% preventable. Not emphasized nearly enough in most of the media reports is that the mom didn’t know she was infected until delivery, so she missed out on the key intervention for preventing HIV transmission — treatment of the mom during pregnancy. And since treating pregnant women has long been standard-of-care, pediatric HIV in the United States is vanishing, a real triumph of prevention. Fewer than 200 cases/year in this country, and counting (down).

So what are the practical implications of this case?

First, in developing countries with high HIV prevalence, where perinatal transmission remains a problem, strategies to aggressively treat the newborns of untreated HIV-positive mothers should be implemented pronto. Second, the case will probably teach us a bit more about how we might someday actually cure more than just a single person here and there.

But for now, the headline to this USA Today piece — “Child’s HIV Cure Won’t Mean New Treatments Immediately” — is the understatement of the year.

Paul Sax is the Clinical Director of Infectious Diseases at Brigham and Women’s Hospital. His blog HIV and ID Observations, is part of Journal Watch, where he is Editor of Journal Watch AIDS Clinical Care.

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