JACKSON, Miss. — The scientific knowledge of HIV/AIDS has come a long way since the disease broke out in the 1980s, but HIV research still has a long way to go. The ‘curing’ of an HIV positive baby in 2013 inspired hope, but the recent reemergence of the disease in her blood is a blow to the scientific community and indicates a need for a greater understanding of the disease.
According to the World Health Organization, 35.2 million people suffer from AIDS around the globe, some 2.3 million of which are newly infected each year. Of these patients, 260,000 are babies born with the disease, which was passed through their mothers’ blood during pregnancy. These children often come from disadvantaged backgrounds, born without prenatal care to mothers who are homeless or impoverished. As an unfortunate result, these babies have less exposure to good medical care once diagnosed with HIV.
One baby born with HIV has become a medical phenomenon, known as the Mississippi baby. The little girl was born in 2010 with HIV, and started treatment at the University of Mississippi Medical Center in Jackson only 30 hours after being born. Since then, her story has become a focal point in AIDS research.
In the past, children born with HIV were treated with a milder cocktail of antiretroviral drugs than adults to little benefit. However, Dr. Hannah Gay, who has managed the Mississippi baby’s case since the beginning, recognized the need for a new tactic and chose to give the child a more potent combination of drugs from the start. The baby remained on these drugs until she was 18 months old.
By March of this year, she appeared to be HIV free, even after a lapse in treatment.
However, the case that once inspired hope for a cure has taken a dark turn. Recent tests have found the virus in the baby’s blood once again, sparking frustration and confusion for AIDS researchers around the world.
“It was a punch in the gut to see those test results last week,” Gay said. “I know intellectually the child is going to be fine, but with a lifetime of medicines ahead, it’s more than just a little disappointing.”
But the new information from the Mississippi baby’s case will affect more than one newborn with HIV. An upcoming National Institutes for Health study that planned to use the same method of treatment from the Mississippi baby’s case could be put in jeopardy.
The research planned to give 450 babies from around the world the same cocktail of powerful treatment for 48 weeks, and then take them off treatment to see if they were free of HIV reservoirs. So far, no patients have signed up, no doubt in part because of the uncertainty of success.
“We’ve got to go back and look at the trial’s design,” said Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases.
Currently, another baby in Los Angeles born in 2013 is receiving the same immediate and strong treatment as the Mississippi baby. While she looks to be in remission, she remains on the drugs, meaning doctors are unsure whether reservoirs exist that would cause a relapse if treatment were to be stopped.
The Mississippi baby would have been the second patient successfully cured of HIV. An adult known as the “Berlin patient” was rid of the disease after a stem cell transplant from a donor who had a rare genetic mutation resistant to the disease. Five similar, but ultimately unsuccessful, cases have been reported in Canada, and three in South Africa.
On the whole, while the case of the failed treatment of the Mississippi baby is tragic, it does lend some enlightening research.
First off, scientists have known about HIV reservoirs in lymphoid and brain cells for some time, but the Mississippi baby’s case proves that they form much closer to infection than predicted.
“the need to understand the early and refractory viral reservoir that is established very quickly following HIV infection in humans,” said Dr. Dan Barouch, professor at Harvard Medical School and expert on these reservoirs.
The importance of early and aggressive treatment is now fully acknowledged, with focus going forward to be less on treating the disease long after infection and more on preventing reservoirs from forming.
Additionally, it is widely understood that HIV is among the most difficult diseases to extract from the body, but the Mississippi baby’s case showed that it may be possible to weaken the disease through early and forceful administration of antiretroviral drugs.
This also allows the patient’s immune system to be able to better manage the virus on its own.
Understandably, there is much more research on HIV/AIDS left to be done, but hope must remain high.
“Cure research is still very much in the early discovery phrase. When you’re in the early discovery phrase of anything you’re going to try things and many are not going to work and some are going to work,” Fauci said. “I don’t think we’ve gained ground, but we haven’t lost ground.”
From now on, research will emphasize undetectable HIV rates and attacks on reservoirs in every patient, but much still needs to be done. For starters, the politics of the AIDS epidemic must change to allow research to be used to the fullest of its abilities in developing nations. While tests to detect HIV in patients’ blood now only cost $10, the drugs to treat HIV are much more expensive.
Lessons learned from the Mississippi baby and further research must be applied to all HIV patients in the global community, regardless of socioeconomic status. Overall, without further research and efforts to bring aid to disadvantaged HIV patients, AIDS will remain a major health concern around the world.
– Caitlin Thompson