In March, a team of medical researchers revealed that a two-year-old patient had been "functionally cured" of HIV after undergoing unusually early treatment with antiretroviral drugs. The instance marked the second documented case of HIV remission, and was the first such case involving a child.
Today, the same team behind that landmark case is announcing yet another promising development: writing in the New England Journal of Medicine, they report that seven months since the initial announcement, this same child remains free of any signs of HIV infection. "We're thrilled that the child remains off medication and has no detectable virus replicating," Hannah Gay, the child's pediatrician, said in a statement. "She continues to do very well. There is no sign of the return of HIV, and we will continue to follow her for the long term."
"There is no sign of the return of HIV."
The child's aggressive treatment on a three-drug regimen started when she was merely 30 hours old. After being delivered prematurely to an HIV-positive mother, the baby was tested for infection almost immediately after being born. Over a one-month treatment period, researchers noted rapidly declining levels of the virus. Treatment ended when the child was 18-months-old and her mother stopped bringing her in for medical care.
Researchers speculate that early, aggressive treatment stops the formation of what are known as viral reservoirs — pockets of dormant HIV that lurk in immune cells and reactivate infection when drug therapy ends. "Prompt antiviral therapy in newborns that begins within hours or days of exposure may help infants clear the virus," Deborah Persaud, the report's lead author, explained. "[We can] achieve long-term remission without the need for lifelong treatment by preventing such viral hideouts from forming in the first place."
Early treatment deserves credit for the functional cure
The team's latest findings also discount one hypothesis regarding the child. Some medical experts had suggested that she may have been an "elite controller" — a rare case wherein individuals are able to contain the virus without requiring ongoing treatment. Researchers involved in her treatment note, however, that the child doesn't exhibit immune system characteristics associated with that scenario, further bolstering the idea that early treatment deserves credit for the functional cure.
Some 260,000 children are infected with HIV each year, but this aggressive protocol — if validated in future cases — could drastically reduce that figure. Indeed, a federally funded study set to start in 2014 will evaluate the method in more newborns.