virus returned in a child in Mississippi thought to have been cured of HIV infection, dashing hopes that scientists had found a strategy that would have a broad impact. After the girl was 27 months with no detectable virus in the blood, the sobering news "was much like a punch to the gut," said his pediatrician, Hannah Gay of the University of Mississippi Medical Center in Jackson, who spoke at a media conference today.
the "Mississippi baby" received international attention in March 2013 when Gay and colleagues first reported the case. the baby was considered only the second person who had a documented HIV infection who seemed to have been erased. the girl, now 46 months old, received an unusually aggressive treatment with a cocktail of antiretroviral drugs 30 hours after the birth of an infected mother HIV. Typically, doctors give newborns exposed to HIV antiretroviral one until they confirm the virus was transmitted, which takes several weeks. his mother stopped treating her daughter 18 months, which almost always leads to a rapid return of the virus.
As Gay and colleagues described in a detailed report that appeared in November 7, 2013 Issue of The New England Journal of Medicine ( NEJM ), ultrasensitive tests children's blood made it through 30 months found nucleic acid traces of HIV, but no virus that could copy itself. The researchers suggested that early aggressive treatment may have limited the size of the "reservoir" HIV -the tough pool that remains in people who have undetectable levels of virus or somehow left only remnants of which crippled could not replicate.
so much excitement built around the idea that the US National Institute of Allergy and Infectious Diseases (NIAID) announced in March to conduct a clinical trial in other newborns. Now, "we will take a good hard look at the study and see if it needs any changes," said NIAID Director Anthony Fauci, who spoke today with Gay and others in the conference call. "We have a situation which is obviously disappointing, but nevertheless there are certainly a lot of confusion problems that arise and that will trigger intense debate and further study, particularly as regards the persistent reservoir in the absence of our ability to detect. What happened with this case is very important. "
Steven Deeks, who conducts research on the HIV cure at the University of California, San Francisco, was surprised by the discovery." This virus is more difficult than we thought, "said Deeks. "He drove home we supersensitive more tests need to detect very few viruses. Or we'll have to monitor these people "clinically cured" for years. "
Gay discovered that the virus had returned when the child came for a routine checkup last week, she . made every 6 to 8 weeks Two separate blood tests showed more than 10,000 copies of HIV per milliliter of blood the last child tested negative on ultrasensitive assays in April;. a sampling of June blood is being analyzed now . She immediately began treatment last week, and Gay said his patient is doing well.
In clinical studies of adults whose blood tests the same negative for HIV, researchers often analyze more remote sites that can harbor reservoirs of viruses, such as the lymph nodes, spinal fluid or intestine. These tests are usually performed before and after people decide to stop treatment. In the case of Mississippi, the mother independently decided to stop treatment, so as before and after the analyzes were not justified. "Clearly, this case highlights the need for it," said Deborah Persaud, a pediatrician at the Johns Hopkins Children Center in Baltimore, Maryland, who led the analysis of blood and was the principal author of NEJM paper. "other children in Mississippi antiretroviral therapy studies will help inform our [clinical trials] move forward."
0 Komentar