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Shots - Health News
Thu March 6, 2014
Second Baby Cleared Of HIV. Rare Event, Or Hope For Others?
Originally published on Fri March 7, 2014 8:01 am
In only the second documented case of its kind, an infant born with the AIDS virus may have been cured of the infection, thanks to an intensive drug treatment begun just hours after her birth. The baby girl — now 9 months old — from Long Beach, Calif., is still on that regimen of antiretroviral drugs. But researchers who described her case at an AIDS meeting in Boston this week say advanced testing suggests that she is HIV-negative.
The California child's case comes three years after doctors apparently cleared an infant in Mississippi of her HIV infection shortly after she was born. That child is now a healthy 3-year-old who seems to be free of HIV, doctors say, despite having been off the AIDS drugs for almost two years now.
Researchers are eager to determine if the two remarkable cases are rare experiences or a broader sign of hope for the hundreds of HIV-infected babies born each day. To find out, clinical trials involving roughly 60 newborns will begin as early as this April or May, says Dr. Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases.
Fauci, whose institute funded the research in both cases, sat down on Thursday with NPR's Audie Cornish, for All Things Considered, to talk about the two children, and what their promising experience might mean for the future. Here's an edited excerpt of their conversation:
How is this course of treatment different from what's usually given to babies infected with HIV?
In the usual situation when a baby is born to an infected mother, you don't know at birth, for sure, if the baby is infected. So what you do is you give the baby what's called a preventive type of drug [regimen] — lower dose and [fewer drugs]. When you find out that the baby is ultimately infected, you switch over to the full component of three drugs at the right dose, to start treating them. ... The original Mississippi baby and the baby from California were treated within hours of birth as if they were infected. So instead of giving them the prevention type of drug over a period of a few weeks, they were immediately given the full-blown course of the treatment drugs.
But how did doctors know when to stop treatment in the first case — the little girl born in Mississippi?
The doctors would never have just ... stopped drug [treatment] in the baby after several months. The mother was lost to follow up and [she apparently] stopped giving the drug to the baby. And then when [the mother and child] came back, the physician noticed that [the little girl] had been several months off therapy and the virus did not rebound. So a quirk — of the mother's decision, or accident, in not following up with the baby — has actually led to a situation that turned out to be beneficial.
So that case was accidental. How will doctors know in the future when to stop drug treatment, and is that even ethical?
To just ... stop would not be ethical, and that's the reason why we're sponsoring a clinical trial that will begin sometime at the end of April [or] at the beginning of May, where we're taking a large number of babies ... born of mothers who are infected, [women] who have not received any [anti-HIV] treatment [during pregnancy] at all, and we're going to be treating those babies literally within 48 hours of birth with the full component of the treatment regimen. [We will be] assuming that they are infected, even though they might not be. And then we'll wait for a considerable period of time, and very carefully, in individual babies, stop therapy to see if the virus rebounds.
Give us some context. Just how big a problem is it — babies born HIV-positive?
In the United States, it's really not a big problem at all only because we have the [prenatal and postnatal] care for the mothers, and almost all mothers who are infected will be started on [antiretroviral drug] therapy. It will be extremely unlikely that the baby will be infected – not impossible but very, very unlikely. However, the situation in the developing world is somewhat different. [There] it's not uncommon that a mother will come into a clinic, in labor, ready to deliver, never having seen a health care provider, and not being on antiviral therapy. Those are the babies that are at the highest risk.
How promising are these findings?
Well, it's quite promising because if it's the second one that we have documented now — and there probably will be others coming along — it really brings up a broader concept. If you have the possibility of truly curing babies at the time of birth, then the risk/benefit ratio of waiting until you document that they're infected ... that really changes the equation.
AUDIE CORNISH, HOST:
Encouraging news out of a medical conference in Boston this week. Researchers presented early findings in a case of a baby born HIV-positive. After aggressive drug treatment, the baby girl is now testing HIV-negative. Born in Long Beach, California, she was given anti-retroviral drugs, ARVs, four hours after birth and remains on them nine months later.
This is apparently the second such case of a newborn treated successfully for HIV. A baby born in Mississippi three years ago was also given ARVs shortly after birth and so far remains HIV free.
For more, we're joined by Dr. Anthony Fauci. He's director of the National Institute of Allergy and Infectious Diseases, which funded the research in both cases. It's also part of the National Institutes of Health. Welcome to the program, Dr. Fauci.
DR. ANTHONY FAUCI DIRECTOR: Thank you. It's good to be here.
CORNISH: So, first, I'd like you to explain the course of treatment. How is it different from the treatment usually given to babies infected with HIV?
DIRECTOR: Well, in the usual situation, when a baby is born from an infected mother, you don't know at birth for sure if the baby is infected. So what you do is you give the baby what's called preventive type of drugs; lower dose and less in number. When you find out that the baby is ultimately infected, you switch over to the full components of three drugs at the right dose to start treating them.
CORNISH: So it's more drugs at a higher dose.
DIRECTOR: More drugs at a higher dose. The patients that were reported in the meeting in Boston, the original Mississippi baby and the baby from California, were treated within hours of birth as if they were infected. So instead of giving them the prevention type of a drug over a period of a few weeks, they were immediately given the full-blown course of the treatment drugs. And it turns out, at least in the Mississippi baby, that may have cured the baby because they can't find the virus and maybe even after being off therapy.
The California baby, we still have some proof to do. The baby has been on therapy for nine months but they have not stopped therapy.
CORNISH: Now, at what point will doctors stop the drug treatment? Is it even ethical to do that?
DIRECTOR: Well, to just empirically stop would not be ethical. And that's the reason why we are sponsoring a clinical trial that will begin sometime at the end of April or the beginning of May, where we are taking a large number of babies of similar situation - babies born of mothers who are infected, who have not received any anti-natal treatment at all - and we are going to be treating those babies literally within 48 hours of birth with the full components of the treatment regiment assuming that they are infected, even though they might not be. And then we'll wait for a considerable period of time and very carefully in individual babies stop therapy to see if the virus rebounds.
CORNISH: And we should say this is all very different than the case of the baby born in Mississippi in which the mother stopped treatment.
DIRECTOR: Right. The doctors would never have just empirically stopped drug in the baby after several months. The mother was lost to follow-up and stopped giving the drug to the baby. And then when they came back, the physicians noticed that it had been several months off therapy and the virus did not rebound. So a quirk of a mother's decision or accident in not following up with the baby has actually led to a situation that turned out to be beneficial.
CORNISH: We've reported on this program that there are already extremely effective drug regimens for preventing the birth of HIV-positive babies. But give us some context here. Just how big a problem is it babies born HIV-positive?
DIRECTOR: In the United States, it's really not a big problem at all only because we have the anti-natal care for the mothers and all those all mothers who are infected will be started on therapy. When the mother is on therapy then it is extremely unlikely that the baby will be infected, not the impossible, but very, very unlikely.
However the situation in the developing world is somewhat different where it's really not uncommon that a mother will come into a clinic in labor, ready to deliver, never having seen a health care provider and not being on antiviral therapy. Those are the babies that are the highest risk. So it really depends on where in the world you are whether this kind of immediate treatment would be applicable.
CORNISH: Dr. Anthony Fauci, he's director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
Thank you so much for speaking with us.
DIRECTOR: Thank you. Good to be with you.
(SOUNDBITE OF MUSIC)
CORNISH: You're listening to ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.