Back in July, it was revealed that HIV had returned in the "Mississippi baby" thought to have been functionally cured of the virus after receiving early antiretroviral therapy. Now, a new case report published in The Lancet reveals that another baby believed to have been cured of HIV in Milan, Italy, now has detectable levels of the virus in his blood.
The baby boy was born to a mother with HIV (human immunodeficiency virus) in 2009, and it was determined 12 hours after birth that he also had the virus.
Prof. Mario Clerici, of the University of Milan and the Don Gnocchi Foundation in Italy, and colleagues report that the child received antiretroviral therapy (ART) 4 days after his birth.
When the child reached 3 years old, tests revealed that he had no detectable HIV or HIV antibodies in his blood, indicating that the virus had been eradicated. "In view of these results and recent reports of apparent cure of HIV infection, and in agreement with the mother, we stopped ART," the researchers say.
But hopes for a cure were short-lived. Two weeks after ART was stopped, tests revealed that the virus had returned. "In our patient, even with apparent clearance of the virus, HIV was not eradicated," the team says.
Prof. Clerici and colleagues note that the child had a very high viral load at birth, which may partly explain why the virus was not eradicated in the long term. The child also had an infection while in the womb and was a very low weight at birth, which could have prevented HIV eradication.
A cure for HIV - the search so far
This report is the latest to curb promise of an HIV cure. In July, Medical News Today reported that HIV had rebounded in the Mississippi baby thought to have been cured of the virus.
- More than 1.1 million people in the US are living with an HIV infection, although 1 in 6 do not realize they are infected
- In 2010, the highest number of HIV diagnoses in the US occurred in California, followed by Florida and Texas
- In 2011, there were 49,273 new diagnoses of HIV in the US.
The baby - also born to an HIV-positive mother - received ART 30 hours after birth. ART was stopped when the baby was 18 months old, after it appeared the virus had been eradicated.
The child remained HIV-free for almost 2 years, before tests showed that the virus had reappeared earlier this year.
There is one man, however, who is still free of HIV more than 5 years after stopping ART. Timothy Ray Brown - known as the "Berlin patient" - was diagnosed with HIV in 1995. He underwent ART for 10 years, before being additionally diagnosed with acute myeloid leukemia.
After receiving chemotherapy and radiation therapy, Brown had a bone marrow transplant from a donor who had a CCR5 gene mutation that stops HIV from entering human cells. Last year, it was confirmed that, 5 years after ART ceased, Brown had no detectable HIV in his blood.
Recently, MNT reported on a study in PLOS Pathogens claiming that it is unlikely the radiation exposure prior to the bone marrow transplant was behind the cure.
The authors say it is more likely to be down to the stem cell transplantation from the donor with a gene mutation or a "graft versus host" response - in which donor cells see host cells as invaders and attack them, eliminating HIV-infected cells in the process.
Important immune system mechanisms detected in latest case
In this latest report, however, Prof. Clerici and colleagues note that there are major differences between this case and those of the Mississippi baby and the Berlin patient.
They point out that even when the HIV virus was undetectable in the child's blood, his immune system continued to act as if it was fighting the infection. The team adds:
"The presence of immune activation, impairments in the memory-naive differentiation pathway, and HIV-specific cytotoxic T lymphocytes suggested ongoing viral replication.
These findings differentiate the case from the Mississippi child and the Berlin patient, in whom HIV-specific T lymphocyte-mediated immune responses and immune activation were not detected or were absent."
The researchers conclude, however, that this case and that of the Mississippi baby indicate that although antiretroviral drugs are effective in reducing HIV morbidity and mortality, they are ineffective in eliminating viral reservoirs so are unable to eradicate HIV.
As Prof. Clerici and colleagues say: "The search for an HIV cure continues."
A commentary recently reported by MNT puts some positive light on the recent blows to hopes of an HIV cure. Researchers from Johns Hopkins Medicine in Baltimore, MD, say that rebounds of HIV in those believed to have been cured of the virus help to understand what needs to be done to eradicate the virus once and for all.