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By Jack Mazurak
In the middle of a global media tornado of interest surrounding Dr. Hannah Gay’s functional curing of an HIV-infected child, the quiet, thoughtful Mississippi pediatrician never faltered. Under TV studio lights and in front of lens after lens, she answered questions pleasantly, spoke in smooth, matter-of-fact tones and gave answers that were as thorough as they were concise.The storm of interview requests from local, national and international media hit in early March after Gay and her two collaborators discussed their findings in the Mississippi-born infant’s case during a major infectious diseases conference in Atlanta.“We’re extremely proud of Dr. Gay’s work and for all she’s done in her career to improve the lives of Mississippi’s children,” said Dr. James Keeton, UMMC vice chancellor for health affairs. “She’s the kind of physician who takes a deep personal interest in her patients and in moving forward HIV care in a careful, evidence-based way.”In late summer 2010, medics transferred a newborn baby to the Blair E. Batson Hospital for Children from another Mississippi facility. The mother found out during labor that she was infected with HIV.Gay, associate professor of pediatrics and an HIV specialist, took over the infant’s care. Experience told her the child stood a high risk for infection. She decided to treat the infant, then just more than 30 hours old, with a three-drug antiretroviral therapeutic prescription.Currently, high-risk newborns — those born to mothers with poorly controlled infections or whose mothers’ HIV status is discovered around the time of delivery — receive a one-or-two drug antiretroviral combination at prophylactic – or protective – doses for six weeks. Only if infection is diagnosed do they begin therapeutic prescriptions.Gay’s previous findings – and those of others in the field – pointed to better viral control with earlier intervention.Dr. Owen “Bev” Evans, professor and former chair of pediatrics at UMMC, said he’s not surprised Gay made the right call.“Hannah’s always been one of the most intelligent physicians I’ve ever known,” he said.“She used her experience and clinical intuition. She knew the child was likely infected and, with the clock running, the risk of not treating was greater than the risks of treatment.”
Dr. Gay addresses media on March 1.
Tests returned a few days following birth confirmed an HIV infection. Gay kept the infant on therapy for 18 months, when the child was lost to follow-up care. For five months the child didn’t receive the medications. A team of case managers at the Mississippi State Department of Health worked to track down the child, as with many such cases.When the child returned to her care, Gay said, she expected the viral loads to have spiked. Except they hadn’t. The standard clinical blood test for HIV came back clean. “My first thought was ‘Oh no, I’ve been treating a child who wasn’t infected.’”But looking back over the results from the baby’s first month of life, Gay saw no doubt, the child had been infected. Gay ordered tests for HIV-specific antibodies, the standard clinical indicator of HIV infection, and for HIV DNA which detects the virus within infected cells. Both came back negative.She contacted her friend Dr. Katherine Luzuriaga, an immunologist at the University of Massachusetts Medical School. The two then called on Johns Hopkins Children’s Center virologist Dr. Deborah Persaud.Using ultrasensitive laboratory tests, the researchers verified Gay’s clinical results.In their case report describing the world’s first case of a functional cure of an HIVinfection in an infant, the three theorized quick administration of therapy kept thevirus from establishing itself in the child.The three submitted their abstract for the 20th Conference on Retroviruses and Opportunistic Infections in downtown Atlanta. Persaud presented it on Monday, March 4.The media storm included interview requests from numerous BBC shows, Time Magazine, the Associated Press, the U.K. Guardian, Nature, Bloomberg, CNN, ABC News, National Public Radio, New York Times, Wall Street Journal, USA Today, Al Jazeera, Huffington Post, El Colombiano newspaper, FOX News, Reuters and others. Gay stressed prevention, which can prevent 98 percent of newborn infections. Luzuriaga said complete viral eradication is the big goal.“But, for now, (that) remains out of reach, and our best chance may come from aggressive, timely and precisely targeted use of antiviral therapies in high-risk newborns as a way to achieve functional cure,” Luzuriaga said.“Without the nurse practitioner and RN case managers in my division there would be no hope of getting even a small percentage of the babies in Mississippi treated appropriately,” she said of nurse practitioner Amy Smith and nurses Nita Boudreaux, Daphne Sigler and Tommie Bays.“Although he was not involved in this case, my colleague, Dr. Ben Nash (assistant professor of pediatric infectious disease), who treats HIV-infected women during pregnancy directly prevents this kind of case from coming up on a regular basis.”The physicians called for research into early therapeutic treatment in high risk babies.“Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or is something we can actually replicate in other high-risk newborns,” Persaud said.Gay said careful and thorough research would show whether that’s possible, and that studies are already being designed. She emphasized that not enough data exist to recommend changing the current practice.The child remains under Gay’s care and off antiretroviral medication. The mother and child have elected to remain anonymous.Gay receives clinical-care funding through the federal Health Resources and Services Administration’s Ryan White HIV/AIDS Program, administered via contract through the Mississippi State Department of Health.Research into the case was funded by the National Institutes of Health and by the American Foundation for AIDS Research.
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