Good riddance. Deborah Persaud during a press conference described the child cured of HIV infection.
Jon Cohen
ATLANTA -A baby in rural Mississippi seems to have been cured of HIV infection, probably because doctors began treatment 30 hours after birth. This is "the first documented case" of its kind, says pediatrician Deborah Persaud at a press conference held at the beginning of the 20th Conference on Retroviruses and Opportunistic Infections here. Persaud, who works at the Johns Hopkins School Bloomberg public health in Baltimore, Maryland, has not treated the child herself, but made intensive studies of blood samples that she and her colleagues were led to conclude that the unusually early treatment may have set the stage for 2 and half years rural Mississippi whose sex and guardians are not identified for privacy reasons to erase a robust infection.
As explained Persaud, the child is born in July 2010 in a rural hospital after 35 weeks gestation, and only learned doctors of HIV from the mother infection from a rapid test given to her when she was at work. due to the premature birth the doctors decided to move the baby to the University of Mississippi Medical Center (UMMC) in Jackson. UMMC conducted separate tests on 2-day-old infant and found both RNA and DNA of HIV. Doctors decided to start a cocktail of AZT and two other anti-HIV medicines 31 hours after birth. Generally, Persaud noted, up to 6 weeks may pass before the laboratories perform both tests needed to determine whether a newborn has an HIV infection, but this baby's hospitalization led to testing and more aggressive treatment.
Laboratory tests at 6, 12, and 20 days confirmed the baby had HIV in plasma. But in 29 days, the virus became undetectable on standard tests, as often happens with effective cocktail of antiretroviral drugs. For unknown reasons, the child's guardian decided to stop treatment at 18 months. In the fall of 2012, when the baby was 21 months old and returned to care, UMMC Hannah Gay pediatrician could not find the HIV virus or antibodies on standard tests. Gay then contacted Katherine Luzuriaga at the University of Massachusetts Medical School in Worcester for help, who in turn asked Persaud Hopkins group to traverse the blood samples for evidence of the persistence of HIV.
The team Persaud, who has ongoing studies of babies who start treatment early and uses a range of utlrasensistive tests to screen blood for HIV, first tested the baby's blood 24 months after birth. The researchers found that only one copy of HIV RNA in plasma. These genetic evidence is often defective versions of the virus that can not be copied. To determine if the baby was home "replication competent" HIV, they mixed the baby's blood with the main target CD4 cells HIV uninfected see if they produce new viruses. They do not have. Other tests at 26 months yet found tiny genetic traces of the virus, but it does not seem to have integrated with cells, it needs to do to copy. "We are very happy and planning new studies to assess this," said pediatrician Lynne Mofenson, head of maternal and pediatric infectious disease branch of the National Institute of Child Health and Human Development of the United States.
Persaud, who plans to present its findings in its entirety at a conference session tomorrow suspect early treatment prevented the establishment of a pool of long life CD4 cells that harbor infections latent HIV; these CD4 immune avoid detection and are impervious to antiretroviral drugs because they do not actively produce new viruses. These tanks are a major reason why the virus persists even after decades of antiretroviral treatment.
In the history of the AIDS epidemic, researchers reported one case convince a person infected with HIV, Timothy Brown, treatment is stopped and has not had the return of virus. "We think this is our case Timothy Brown to stimulate interest in research and lead us on the road to recovery for children infected with HIV," said Persaud. It recognizes that, like Brown, this is n = 1 conclusion, and said that the child may still harbor an infection, which is why they refer to the case as a "functional cure" rather than the complete eradication of HIV, called a cure "sterilization". "This is a case and we certainly need to have more, and we hope that we can have more," she said.
transmissionEffective antiretroviral treatment for pregnant women has HIV to infants rare wherever it is used. But Mofenson, who gave a presentation on transmission from mother to child during the opening session of the meeting, noted that worldwide, 330,000 new pediatric infections occurred in 2011. Even in the States STATES, where fewer than 0 babies infected with HIV are born each year, the mother-child transmission occurs too often because treatment guidelines are not followed. Indeed, in this case the rural hospital in Mississippi who diagnosed the mother with a rapid test during labor does provide antiretroviral drugs, and had no syrups AZT and nevirapine on hand which are given to infants at birth in a last attempt to prevent transmission -ditch. "This is unacceptable," said Mofenson.
Persaud is confident that early treatment will lead to functional recovery of other children. "We think we should be able to replicate it," she said. "This has very important implications for HIV infection in children and the possibility of obtaining healing." Mofenson agrees, but warns that it will be much easier to quickly diagnose HIV infection early and treat in rich places like the United States. "It will be very difficult to actually take it and implement in developing countries," said Mofenson. "The key to the elimination of pediatric HIV is to prevent infection in the first place"
Fixed March 4. Due to the premature birth, doctors decided to move the baby to the University of Mississippi Medical Center in Jackson, which was initially reported that the University of Mississippi Medical School.
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