Second Success Raises Hope for a Way to Rid Babies of H.I.V.
BOSTON — When scientists made the stunning announcement last year that a baby born with H.I.V. had apparently been cured through aggressive drug treatment just 30 hours after birth, there was immediate skepticism that the child had ever been infected in the first place.
But on Wednesday the existence of a second such baby was revealed at an AIDS conference here, leaving little doubt that the treatment had worked. A leading researcher said there might be five more such cases in Canada and three in South Africa.
And a clinical trial in which 50 babies who are born infected will be put on drugs within 48 hours is set to begin within three months, the researcher added.
If that trial works – and it will take several years of following the babies to determine whether it has – the protocol for treating all the roughly 300,000 babies born infected each year will no doubt change.
The second baby – a girl born in Long Beach, Calif. – is now 9 months old and free of the virus that causes AIDS.
Pediatricians at Miller Children’s Hospital in Long Beach had heard of the first baby, born to a mother in Mississippi with advanced AIDS who had not taken any drugs to protect the fetus. The California doctors tried to replicate that first treatment.
They immediately gave the baby three antiretroviral drugs — AZT, 3TC and nevirapine — at the higher doses normally used for treatment rather than for prevention, and never previously recommended for newborns.
It would be wrong to describe the Long Beach baby as “cured” or as “in remission” because she is still on antiretroviral drugs, said Dr. Deborah Persaud, a virus specialist at the Johns Hopkins Children’s Center who has been involved in both cases. She describes the baby as “sero-reverted to H.I.V.-negative.”
The baby was treated nine hours after being born – as soon as her first H.I.V. test came up positive – and now even ultrasensitive tests can find no virus in her blood or any tissues.
“Last year, when we described the Mississippi baby, the report was received with some skepticism,” Dr. Persaud said. But since viral DNA and RNA were found in the Long Beach baby’s blood and spinal fluid, “this baby was definitely infected,” she added, “and now we are unable to detect replication-competent virus.”
The Mississippi baby, now 3 years old and known as the “Mississippi child,” is healthy and still virus-free, Dr. Persaud added.
That baby, whose name and sex have not been disclosed, was born to a mother who got no prenatal care and was unaware that she was infected. When it was suspected that the baby was infected, it was transferred to the University of Mississippi Medical Center and started on aggressive antiretroviral treatment about 30 hours after birth by a pediatrician who felt that the regular prophylactic regimen would not save a baby at such high risk.
Then, 18 months later, the mother stopped seeing doctors and stopped giving her baby the drugs for five months. When she then took the baby back in, alarmed doctors assumed that it would be teeming with virus. Instead, to their astonishment, they found none. And samples taken by Dr. Persaud and tested with ultrasensitive assays at her Hopkins laboratory have found none.
Very few babies are born infected in the United States each year because mothers usually get drugs to lower their virus levels and protect their babies.
Although the Long Beach mother had been prescribed drugs to protect her child, Dr. Persaud said, she had not taken them.
An H.I.V. blood test given at four hours of life showed that the infant was infected, presumably in the womb rather than during the birth itself.
Doctors immediately started the child on the three-drug antiretroviral cocktail.
Dr. Persaud’s lab is now unable to find any virus in the girl’s blood or tissues, even with ultrasensitive assays. They are normally able to detect dormant virus hiding in tissues in any patient whose infection is controlled by drugs.
Antiretroviral drugs prevent the virus from replicating itself. But a small amount normally persists in “reservoirs” throughout the body, which can be activated with drugs and made to yield virus for testing.