After nearly 2 years of not taking antiretroviral therapy (ART) without any evidence of the virus returning, detectable levels were discovered during a routine clinical care visit at the start of the month. Repeat testing confirmed this finding 72 hours later.
Tests also found evidence of an actively replicating pool of the virus within the child's body. The child, now nearly 4 years of age, has once again started on ART, and presently the treatment is reducing the virus levels.
Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), said that the news put HIV research into perspective:
"Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child's care, and the HIV/AIDS research community. Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body."
The "Mississippi Baby"
Medical News Today had previously reported twice last year about the "Mississippi Baby;" once when news broke regarding the believed curing of the virus, and then later when an update on the child's condition was announced.
The "Mississippi Baby" was claimed to be the first ever case of a cure in an HIV-positive infant, and it was hoped that the findings would pave the way toward the elimination of HIV in children.
The baby was originally given ART within 30 hours of birth, after being delivered to an HIV-infected mother who had not been diagnosed until the time of her delivery. As a result, the mother had not been given any antiretroviral medication during the term of her pregnancy.
Combination ART was administered and after 28 days it was found that the HIV in the baby's blood was undetectable by standard tests.
ART was continued until the baby was 18 months old, at which point the "Mississippi Baby" became lost to follow-up, effectively ending her treatment. Ten months later, however, the child's blood was tested once more and, much to the surprise of the doctors, the tests came back reporting that the child was virus free.
Repeat testing confirmed that these results were correct, suggesting that the child was functionally cured.
A functional cure is one where a viral presence is so minimal that it cannot be detected by standard clinical tests, as opposed to a sterilizing cure which occurs when all viral traces are completely eradicated from the body.
In October last year, it was reported that the child was still in remission 18 months after her combination ART had been stopped. The researchers believed that this suggested that their initial findings were no fluke and that indeed the "Mississippi Baby" was the case of a functional cure in an HIV-positive infant.
Sadly, this was not to last.
Case is 'still important research'
"The case of the Mississippi child indicates that early ART in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period," says Dr. Fauci.
Doctors and professors believe that the fact that the child remained functionally cured for such a long time is important and that research will be required into why it happened and whether the period of remission can be prolonged.
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) issued a statement saying that it strongly supported clinical trials and continued research being lead by the National Institutes of Health, the Johns Hopkins University and other groups into how the way in which the "Mississippi Baby" could lead to a potential cure for HIV.
Dr. R. J. Simonds, vice president of program innovation and policy at EGPAF, stated that what had been learned from this case needed to be taken on and applied to future studies:
"Although we had high hopes that the child would remain HIV-free, this case represents important research that still provides a tremendous learning opportunity about how rapid, early treatment affects the body's response to HIV, especially in newborns, which eventually could lead to a cure."
For now though, the child continues to receive medical care, monitoring and treatment. Hopefully, the information gathered through her initial treatment can lead one day to an eventual permanent cure.
June 27th was National HIV Testing Day and to coincide Medical News Today ran a feature investigating what was discouraging HIV testing among at-risk populations.
Written by James McIntosh