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Published in CenterView on November 04, 2013

Functionally cured HIV baby still virus free

By Jack Mazurak

A 3-year-old Mississippi child born with HIV and treated with a combination of antiviral drugs unusually early continues to do well and remains free of active infection 18 months after all treatment ceased, according to an updated case report published Oct. 23 in the New England Journal of Medicine.

Dr. Hannah Gay, associate professor of pediatrics (infectious diseases) and her colleagues at the Johns Hopkins Children’s Center and the University of Massachusetts Medical School initially presented their findings on the case in March during a scientific meeting in Atlanta.

The newly published report adds detail and confirms what Gay and her colleagues say is the first documented case of HIV remission in a child. The case’s specifics also fit the definition, recently established by an HIV expert group, of a functional cure in the young girl.

“We’re thrilled that the child remains off medication and has no detectable virus replicating,” Gay said. “We’ve continued to follow the child, obviously, and she continues to do very well.

“There is no sign of the return of HIV, and we will continue to follow her for the long term.”

The child was born to an HIV-infected mother and began combination antiretroviral treatment 30 hours after birth. The infant remained on antivirals until 18 months of age, at which point she was lost to follow-up for a while and, physicians say, stopped treatment.

Upon return to care, about 10 months after treatment stopped, repeated standard HIV tests detected no virus in the blood, according to the report.

The investigators say the prompt administration of antiviral treatment likely led to the Mississippi child’s remission because it halted the formation of hard-to-treat viral reservoirs — dormant HIV hiding in immune cells that reignites the infection in most patients within mere weeks of stopping drug therapy.

As a result, a federally funded study set to begin in early 2014 will test the early treatment method used in the Mississippi case to determine whether the approach could be used in all HIV-infected newborns.