Child 'Cured' of HIV Remains Free of Virus: Report
Treatment started shortly after birth seems to have kept virus from getting a foothold in her immune system
Doctors next saw her about 10 months after her treatment ceased. The child underwent repeated standard HIV tests, which detected no virus in her blood.
The two factors -- timing and medication -- appear to have prevented HIV from gaining a foothold in the girl's immune system. The virus was unable to create a reservoir in her body in which dormant HIV can hide and later reignite when drug therapy is suspended.
"What studies in other babies have shown us is if you treat very early, you're not only able to treat the viral replication but also able to limit the number of cells in which HIV integrates itself into the host genes," Luzuriaga said. "Basically, HIV makes copies of DNA and that DNA integrates itself into host genes. That's the barrier to cure. As long as you have those white blood cells floating around the body that have HIV stitched into the host DNA, the patient is not cured."
A key point is that the child exhibits none of the immune characteristics seen in "elite controllers," the tiny percentage of HIV-infected people whose immune systems are so active that they can keep the virus in check without treatment, the researchers said. The absence of these characteristics indicates that early therapy -- rather than natural immune mechanisms -- led to the child's remission.
Based on this girl's case, a federally funded study set to begin in early 2014 will test the early treatment method to determine whether the approach could be used in all HIV-infected newborns.
This method could cure newborns infected with HIV but is unlikely to help adults, given that they rarely learn of their infection until months or years after transmission, said Dr. Rowena Johnston, vice president of research at the Foundation for AIDS Research (amfAR).
"If there is something key to treating HIV within the first couple of days of transmission, it's going to be incredibly difficult to treat adults in this manner," Johnston said. "But this case really opens up the possibility that there may be different HIV cures for different populations, depending on what the circumstances are."
Dr. Michael Horberg, director of HIV/AIDS treatment and research for Kaiser Permanente, agreed that the infant's case is very encouraging, but said it's not an indication of a potential cure for all people with HIV.
"This is a very unique situation, but it does show that very early treatment is very successful," Horberg said. "We can envision potential future pathways with correct medication and vigilance where there might be a percentage of patients who could be successfully treated."
Only one other instance of an HIV cure has been documented, in the so-called "Berlin patient." An American man living in Germany received a bone marrow transplant for leukemia, with cells from a donor who had a rare genetic mutation that increases immunity against HIV. This patient has remained HIV-free after discontinuing drug therapy.