Cautious Optimism About 'Cure' for Babies With HIV
Report on second child raises hope that early, aggressive treatment may be game changer for these infants
The mother of the California baby has advanced AIDS and is mentally ill, researchers said. She had been prescribed HIV medications to protect her baby, but had not taken them, according to published reports.
Normally, doctors put children born to HIV-positive mothers on a two-medication regimen until the virus appears in the babies' bloodstream, which can take as long as two weeks. At that point, they move to a more aggressive three-drug regimen.
But in the cases of the Mississippi and California babies, doctors chose to quickly put the newborns on the more aggressive regimen, with stunning results.
Fauci noted that doctors can't yet call the California baby "cured" of HIV infection because she remains on the antiretroviral drug therapy.
"The proof of the pudding is when you take the baby off therapy, and the virus does not bounce back," he said.
The Mississippi baby provides a more striking case because doctors lost track of the mother and child 18 months after her birth, at which point drug therapy ceased. Doctors next saw the child about 10 months later, and were surprised when they found that the girl remained HIV-free despite receiving no further treatment.
"You can say with a much higher degree of confidence that the Mississippi baby is definitely cured," Fauci said.
The timing and the heavy medication dose apparently may have prevented HIV from gaining a foothold in the infants' immune systems, said Dr. Roberto Posada, an associate professor of pediatric infectious diseases at the Icahn School of Medicine at Mount Sinai, in New York City.
HIV typically creates a reservoir in the bodies of those it infects, where it can lay dormant and later return when drug therapy is suspended.
Because adults often don't find out they have been infected until months or years later, it's unlikely that the successful treatment of these babies would have any implications for adult HIV therapy, Posada noted.
"It's difficult to extrapolate these results to adults because babies are so different from adults," he said. "Their immune systems are at a different stage of development, and you know exactly when they have been infected with HIV -- at birth."
At the same time, these findings do emphasize the importance of treating HIV in adults as early as possible, Fauci said.