The key to curing HIV in children may be early treatment

An electron micrograph of the HIV virus in an image courtesy of the CDC. (Image credit: Reuters)A two-and-a-half year old child from Mississippi has become the first documented case of a baby born with HIV being cured, and it may be due to receiving early treatment for the virus.

The baby was born five weeks premature, in July 2010, in a rural Mississippi hospital. Doctors only discovered that the mother was carrying HIV — human immunodeficiency virus — during a routine blood test when she arrived at the hospital delivery room, and tests after the delivery showed that her child was infected as well. The baby was transferred to the University of Mississippi Medical School (UMMS) in Jackson to receive more advanced care, and doctors there confirmed the virus and started the baby on a combination of ATZ — a drug used to delay the development of AIDS in those infected with HIV — and two other anti-HIV medications, when the child was just 31 hours old.

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For the next three weeks, tests continued to confirm the virus in the child's blood, but after 29 days, the virus became undetectable to the standard tests used. This typically happens when someone is on anti-HIV medication, so it was not considered a cure at that time, and treatment continued. When the child was 18-months old, the baby's caretaker stopped treatment, but then returned three months later. When doctors tested the baby's blood again, they found no traces of the virus or virus antibodies.

Scientists: Baby born with HIV curedA baby born with the virus that causes AIDS appears to have been cured, scientists announced Sunday, describing the case of a child from Mississippi who's now 2½ and has been off medication for about a year with no signs of infection.

Hesitant to call this as cure, they contacted pediatrician Deborah Persaud, who works at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and whose team specializes in early treatment of HIV in babies. Dr. Persaud's team performed ultra-sensitive tests on the baby's blood samples, and found only a single copy of the virus' genetic material, but not enough for the virus to reproduce. Subsequent tests confirmed that these miniscule traces of the virus in the baby's blood were completely inactive and that the child was free from the infection.

"We're very excited and planning new studies in order to assess this," said pediatrician Lynne Mofenson, according to the journal Science. Mofenson is head of the maternal and pediatric infectious disease branch of the U.S. National Institute of Child Health and Development.

The key to this cure is, apparently, the early treatment against the virus. The doctors that treated the child delivered a strong treatment plan very early after the child was born, which apparently was able to have an impact on the virus before it could form 'hideouts' within the child's body.

Viruses, including HIV, are capable of 'hiding out' inside the cells of our body, lying dormant while anti-viral drugs are in the person's system, and then coming out of hiding again when it's 'safe'. A virus needs time to implement this plan, though, so early treatment can block the virus' ability to hide, keeping it out in the open for the anti-viral drugs to take their toll.

Just this morning, it is being reported that scientists in Melbourne, Australia have found a way to flush HIV out of its hiding place, by altering how HIV genes are turned on and off, effectively waking up the sleeping virus so that anti-HIV drugs can detect it and fight it off.

"We know the virus can hide in cells and remain out of reach from conventional HIV therapies and the immune system,” said Professor Sharon Lewin, Director of the Infectious Diseases Unit at the Alfred Hospital, in Melbourne.

"Anti-HIV drugs are unable to eradicate the virus because it burrows deeply into the DNA of immune cells, where it gets stuck and goes to sleep. Anti-HIV drugs are very effective in keeping people healthy but they can’t eliminate virus that is sleeping. We wanted to see if we could wake the virus up – and using vorinostat we have successfully done that."

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As for the case of the Mississippi child being cured of HIV, Dr. Persaud believes that early treatment will lead to curing other children of the disease.

"We think we should be able to replicate this," she said. "This has very important implications for pediatric HIV infection and the ability to achieve cure."

However, although Dr. Mofenson agrees, she is cautions that this treatment will likely only be available in more wealthy nations.

"It will be very difficult to actually take this and implement it in developing countries," she said. "The key to elimination of pediatric HIV is to prevent infection in the first place."

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