Ankur Jain's musings

Functional Cure for HIV in a Newborn Infant

Very cool news over the weekend: Doctors report that they have been able to functionally cure HIV in an infected baby born to an HIV-positive mother in Mississippi. While only a few hundred HIV-infected babies are born in the U.S. every year (thanks to antiviral treatments in pregnant mothers), over 300,000 are born in Africa annually. So this is something that needs to be tackled, Ray Lewis-style.

Why It’s Cool: I want to emphasize that this is a “functional cure”. Like the “Berlin Patient” (who was functionally cured by a completely different process), the virus might still technically be there, but the baby is “cured” for all intents and purposes. Also, this was done by giving the newborn large doses of antiviral drugs that are already available and already used to fight HIV. About a month after birth, the virus was undetectable in the baby’s blood, and on visits months later (even after the mother stopped treating the child for some reason), no HIV was found. The most sensitive tests showed signs of HIV RNA and DNA, which means the virus was there, but no actual virus.

What Questions Remain: This research was presented at a science conference this weekend, and needs to go through the process of peer review to be double and triple-checked, because that’s what we do. Is this the best way to prevent HIV in babies? Not all babies born of HIV+ moms get infected, only about 15-45%. And with methods already in place, that number can be reduced to more like 1%. Did the baby actually have HIV to start? Mothers and babies actually share cells across the placenta, and they are floating in each other’s bodies. Maybe there’s a chance (this is one that I haven’t seen brought up elsewhere) that thetests done to “confirm” the HIV was there to begin with actually detected some of the mother’s cells? I don’t know. Time will tell.

All in all, this is a very cool report of something that hadn’t been done before. But like Sarah Boseley discusses at The Guardian, in the places where HIV+ babies are found the most (sub-Saharan Africa) the problem isn’t finding new methods. It’s getting those methods into practice, and getting mothers and doctors in Africa to take action (often against incredible social resistance). Just this week, “successful” HIV treatments were reported useless in Africa because simply people don’t use them.

Great application of careful medicine, but like the “Berlin Patient”, it probably won’t end up treating HIV where it’s most needed. Not unless something else changes first.