The Mississippi Baby, a baby born HIV-positive, was introduced to the world last year as cured and virus-free. However, several folks in the scientific community remained doubtful about the treatment used to cure the infant because of lingering uncertainty as to whether the child was truly infected to begin with. If truly HIV-infected, then the drug regimen, administered within 30 hours after birth, would become yet another preventive tool useful in protecting babies born to HIV infected mothers.
A new report, presented Wednesday at the Conference on Retroviruses and Opportunistic Infections, described a second baby clearing the HIV virus with a similar regimen, perhaps erasing any doubt the treatment works.
The second baby, a girl currently 9 months old, is free of the virus that causes AIDS. She was born at Miller Children s Hospital in Long Beach California, where her mother arrived in labor, and was found to have advanced AIDS and [be] mentally ill. Unlike the Mississippi baby, there was early evidence this infant was infected. The presence of viral DNA and RNA in the baby s early blood and spinal fluid samples makes it virtually certain she was infected at birth, according to Dr. Deborah Persaud, a virologist from Johns Hopkins Children s Center in Baltimore. Dr. Persaud, who has run tests for both cases, adds that the virus began to disappear six days after birth and was undetectable within 11 days.
However, before any blood test even confirmed the baby girl was HIV positive, her pediatrician, Dr. Audra Deveikis, initiated the baby on an aggressive high dose antiretroviral regimen of AZT, 3TC, and nevirapine--just four hours after birth. Such high doses are uncommon among prevention procedures for newborns, and typically only include a combination of two drugs. Moreover, before beginning newborns on these preventive treatments, confirmation of true infection is generally needed.
Dr. Deveikis upholds her clinical decision saying, Of course I had worries, but the mother s disease was not under control, and I had to weigh the risk of transmission against the toxicity of the meds. Based on her knowledge of the Mississippi baby, Dr. Deveikis adds, I knew that if you want to prevent infection, early treatment is critical.
Since it is considered medically unethical to halt the drug treatment given the baby right now, Dr. Persaud points out, it is incorrect to describe the baby as cured or even as in remission. At the moment, the baby s pediatrician Dr. Deveikis, and Dr. Yvonne J. Bryson, a pediatric AIDS expert at the University of California, Los Angeles, are hoping to stop the treatment if the baby continues to be virus-free when she reaches two years of age.
While the Long Beach baby corroborates the efficacy of the drug treatment used for HIV- infected newborns, it will be further tested in an upcoming clinical trial, where 60 infected babies will be placed on drugs within 48 hours of birth. The success of the trial would lead to major changes, for two reasons ¦both for the welfare of the child, and because it is a huge proof of concept that you can cure someone if you can treat them early enough, said Dr. Anthony S. Fauci, executive director of the National Institute for Allergy and Infectious Diseases.
For researchers and clinicians, the Long Beach baby elucidates and confirms the effectiveness of early intervention and treatment among newborns, but still raises new questions about timing when to stop the drugs. Dr. Steven G. Deeks, an AIDS expert at the University of California, San Francisco, said ¦ starting therapy virtually at birth seems to kill the virus before it establishes a permanent reservoir. But it sure would be nice to have a way to decide when to stop. That s the next question. As such, this future clinical trial and further research must address when it is best to wean children off the treatment.
