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Baby Cured of HIV: Was This a Premature Release?

Posted: 06/03/2013 23:00

On Monday 4 March, the world awoke to a media storm: news was buzzing around the world that a Mississippi baby had been cured of HIV.

We were soon bombarded with a flurry of media reports about how this case was set to change the HIV treatment paradigm, prevent babies from being infected, and, to quote the principal author of the study, Dr Deborah Persaud, "transform our current treatment practices in newborns worldwide".

I'm currently in Atlanta in the USA, where this research was presented at the Conference for Retroviruses and Opportunistic Infections. The news stations here are already asking if this means that children who are infected at birth can stop their drugs. They're asking when the cure will be available, and patients have even been calling their paediatricians at this meeting, raising the question of whether their child could also be cured!

To which I say: STOP. Back up. Rewind.

To quote a famous professor of HIV pharmacology: "We need more data." We need to take stock, get the facts right, and allow for scrutiny of the case by the scientific community.

There are many questions to be asked of the case. For instance, was the baby truly infected in the first place? From reviewing the data presented at the conference, it certainly seems possible. But how established was this infection? Had it established itself in so-called long-lived memory T cells?

Furthermore, when was the actual point of infection? This is not clear. Could it have been just prior to delivery? If so, it is possible that by serendipity the doctors intervened with drugs just as the virus was trying to become established.

It's imperative, then, that we attempt to understand when exactly this baby was infected. Was it just before birth, or several months before birth? The longer the period of time, the more interesting the case becomes.

However, if the intervention simply aborted the establishment of infection then Dr Persaud's results are less exciting.

If drugs were introduced very shortly after infection, the treatment may have actually acted as 'post-exposure prophylaxis' - a strategy already used by HIV doctors to try and avoid establishment of infection

Think of a fire which has just caught alight, but has yet really to take hold. Pouring a bucket of water on it at this point may kill the fire dead. Was there actually a flame, or the presence of detectable virus, in this case? Yes, of course. But this bucket of water may not have worked had you allowed the 'fire' to become properly established.

The case being described by many as a 'cure' may in fact be like this bucket of water - effective, but only because it was delivered so early.

Taking the fire analogy further, after we have put out the flames we may still see the residues it left behind. It might even reignite at a later point in time. The Mississippi baby has been off anti-retroviral drug treatment [ARVs] for less than a year - there are currently no flames, but we are waiting to see if the embers are truly burned out.

Currently, and beyond this headline case, we have no way to completely put out the fire of HIV once it has caught hold. Our current ARV treatments, then, are the firemen who keep the flames of HIV at bay. As long as they are there, you can begin to rebuild the house - a fact born out by the fact that hundreds of thousands of our patients have been on totally suppressive regimens for up to twenty years.

Currently, it is a truth that, if you stop therapy, the virus inevitably rebounds when you - usually within two weeks. Admittedly, there are a very few rare cases where the virus may simply smoulder away at very low levels for many years (so-called "post treatment controllers").

All of these considerations and unanswered questions mean that we have a long way to go yet before we fully understand this case. We must fully explore the baby's immune make-up. What about the characteristics of the mother's virus, which was curiously low for someone not on treatment? There are so many questions before we should really call this a cure.

Other than the potential of Dr Persaud's research to stimulate further investigations, then, what is the best thing that can come of all this media frenzy?

The great hope is that this moment represents the greatest mass HIV awareness campaign since the Don't Die of Ignorance 'tombstone' campaign of the 1980s. Rarely does HIV make such headlines, and we have a real chance to educate people whilst their interest is piqued.

We must tell people that the story of HIV is very different now, and we must take this opportunity to communicate new messages through the media whose attention we currently have - messages which can correct people's out-dated misconceptions.

Let's talk about testing, and the importance of early diagnosis.

Let's talk about effective drugs, which when prescribed early enough can help a patient live a long and full live.

Let's talk about condoms and prevention.

Let's tackle stigma.

Today there is no reason for any baby to be become HIV positive, if the mother is tested and diagnosed early in pregnancy - and if she and the baby have access to effective treatments which can prevent transmission. Sadly, 590,000 babies every year are still born HIV-positive in the developing world: an unnecessary tragedy.

We can do something about that right now, with the tools we have - If we increase testing and make it more regular and consistent. In the UK, 95% of women take the HIV tests during pregnancy. And with effective treatment the chance of the baby being born positive is less than 0.5%. We should be aiming for the same success all over the world

Above and beyond a media storm about a supposed 'cure', there are good news stories we can make happen today.

Is the 'cure' story exciting? Yes. Is it scientifically plausible? Yes. Will it stimulate more research? Almost certainly. But it is extremely premature to hail it as a cure that will translate into routine clinical care any time soon. We need much more data.

So if you or your child are HIV-positive, then please... don't stop taking your tablets. And if you have had unprotected sex, take the test. Condoms, education, testing, and access to treatment are our real weapons against HIV, and we need to learn to use these correctly if we want to make a real impact today.

The presentations of the case, discussion and commentary, can be found at the Saving Lives website.

 

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