On Sunday, the National Institutes of Health reported that a 2-year-old child who was born with HIV infection has been declared "functionally cured." No active or functioning parts of the virus appear within the toddler's blood. News of the toddlers cure will hopefully spurn an increase in awareness and research for the disease, which has seen a decrease in interest by the public over the past decade.
The baby was born in rural Mississippi after the mother went to a hospital, where the child was tested positive for the HIV infection. The mother had not received any treatment for HIV herself or prenatal care, as the mother was not yet aware of her infected status. Antiviral drugs are usually administered prenatally to avoid transmission of the virus to the child. The infant had not received any treatment at the time of birth and initial tests showed that the child tested positive.
When the child tested positive, the hospital made arrangements to have mother and child transferred to the University of Mississippi Medical Center. The hospital where the baby was born did not possess the necessary drug cocktail that is usually administered to children born with the virus.
The New York Times reports that the normal protocol is to give a combination of several antiviral drugs, where this case differs is in the dosage and when the drugs were administered. The doctor began treating the infant at 31 hours of life with a three-drug therapeutic dosage of Antiretroviral or ARVs. Therapeutic dosing refers to the treatment and prevention of the disease, the NIH advocates prophylactic treatment of infants with one-to-two drugs, which only deals with prevention.
The child continued to be treated with ARVs until she was 18 months old, when the mother and child stopped going in for treatments. Dr. Hannah Gay who has served as the child’s doctor had assistance in tracking the child down in order to begin treatment again, but it was discovered that HIV levels were down to nearly undetectable levels.
The infant has not been placed back on ARVs and her progress is monitored by Dr. Gay.
The case presents an opportunity to treat infants earlier and to hopefully prevent the HIV virus from establishing a reservoir in the bodies of children infected with the virus.
The real test will come from replicating the findings of this case.
Finding out how and where the disease hides within the body remains one of the most persistent challenges. There are individuals who possess a mutated gene called delta 32 that blocks the receptor CCR5, which is required by HIV to access immune cells. But there are individuals immune to HIV who have no mutation to their CCR5 receptors.
Timothy Brown, who was infected with HIV and developed leukemia, was an American-born man who moved to Germany. Brown and his doctors sought stem cells from an individual with the known CCR5 mutation. The stem cells that Brown was implanted with contained what is called a double delta, that meant that both parents had the gene that blocked the CCR5 receptor. His doctors figured this was their best chance at curing both the leukemia and HIV from his system. Once the stem cell transplant was completed, and further tests were down, the HIV virus was no longer detectable. Timothy Brown is the only adult to be declared cured from HIV.
Cases like Brown's and the child from Mississippi gain such traction because they give us hope in the face of a seemingly implacable disease. Antiretroviral drugs decrease an individual's infectiousness by 96%, but it is is not a cure. Nor should it be our answer to HIV.
ARVs and ATVs drastically reduce an individual's life years, The Lancet reported in 2008 that if an individual began taking ARVs at the age 20, they could expect to live to 63. The disease still reaps havoc on the body as does the toxic drug cocktail and economically, treatment can cost $30,000 a year.
After a steady decline in public interest and urgency, the real hope of stories like the one from Mississippi is that it will urge the public to call for increased funding for research into a cure and treatment for HIV. It is believed that hundreds of millions of dollars by the government must be spent each year until a cure is found, but that would certainly be money well-spent.