An ongoing dialogue on HIV/AIDS, infectious diseases,
March 5th, 2013
Exploring the Media Fascination with the Baby Cured of HIV
Here’s the story: The mother didn’t know she was HIV positive until delivery, and the baby was found to be infected by both HIV DNA and RNA right at birth. The doctors started combination antiretroviral therapy approximately one day later, essentially as soon as the results came back. There was a good response to treatment, with declining HIV viral loads over the next few weeks that quickly became undetectable.
Successful treatment continued for 18 months, at which time mom and baby were lost to follow-up; the mom stopped the baby’s antiretrovirals. When the two returned to care 5 months later, the baby’s HIV RNA and antibody were both negative — much to the surprise of the doctors. Supplemental testing, using evaluations similar to those done on the Berlin patient, did not yield any evidence of replication-competent virus, and the baby remains off therapy today.
In short, baby cured of HIV. Stop the presses!!! (Do they still say that?) Front page story, New York Times. Look at this Google News Page and the search gadget at the top of this post! Here at CROI, my colleagues and I are all getting e-mails from our friends/family/etc. asking about this “breakthrough.”
And we’re kind of baffled. Because this case will have about as much immediate impact on the HIV epidemic in the United States as the prior cure — that’s right, virtually none. Maybe it will have an impact globally, but that will be a major challenge.
Thinking about it more, however, I understand why this is such compelling news:
- It’s a baby. The media love stories about HIV in babies. The whole “innocent victim” thing is hard to shake.
- It’s a cure. Can’t miss that. And the press is probably hypersensitive about not missing out, since they initially whiffed on reporting the last HIV cure. It was first presented at CROI in 2008 and barely got a peep. Took a resuscitation of the story by the Wall Street Journal and, ultimately, publication in the New England Journal of Medicine for the case to receive major media attention. For the record, rumor has it that a certain highly prestigious medical journal (hint) also initially whiffed on it, rejecting the case report when it was first submitted.
- The public probably doesn’t really understand that HIV in babies is all but 100% preventable. Not emphasized nearly enough in most of the media reports is that the mom didn’t know she was infected until delivery, so she missed out on the key intervention for preventing HIV transmission — treatment of the mom during pregnancy. And since treating pregnant women has long been standard-of-care, pediatric HIV in the United States is vanishing, a real triumph of prevention. Fewer than 200 cases/year in this country, and counting (down).
So what are the practical implications of this case?
First, in developing countries with high HIV prevalence, where perinatal transmission remains a problem, strategies to aggressively treat the newborns of untreated HIV-positive mothers should be implemented pronto. Second, the case will probably teach us a bit more about how we might someday actually cure more than just a single person here and there.
But for now, the headline to this USA Today piece — “Child’s HIV Cure Won’t Mean New Treatments Immediately” — is the understatement of the year.
Skeptics believe that this story of the cure child is not really conclusive. They say that the baby – although at high risk for contracting the virus from her mother – was not actually infected herself. This story shows no actual proof that the baby girl was indeed born with the virus. On the other hand it mentions that the baby, being at high risk of infection, was placed on treatment even before laboratory investigations had been done. That being said, doctors agree that the child was most likely infected, so it’s still a story of hope 🙂
I have been on HIV treatment for about 20 years. I took a break from my meds about 3-5 years ago. I was off them I think close to a year. My viral load stayed undetectable. My doctor requested I start the meds back when my t-cells started going down some. My t-cells have never rebound but hover around 250-300. So this being said does that mean I am cured? Just wondering??
Glad the viral load stayed undetectable, but in most cases this means you may be what is now called an “HIV controller” — meaning you control the virus without meds. I’d ask your doctor to repeat your HIV antibody (just to make sure that the original diagnosis was correct), and if that’s positive, ask him/her about your going back on medications since the t-cells are low.
p.s. we’re studying treatment of HIV controllers in the ACTG, if a study site is near you:
why wont the feds fund this
I’m so glad I found your blog. Follow it regularly and go fishing for further info once you pique my interest about something. I am a nursing professor and practice part-time in HIV care. I’ve already done my HIV/STD lecture this semester, so MANY I’ve students emailed me links to this story early this week. I’m glad they are paying more attention to HIV in the news, but I’ve had to give quite a few “calm down” explanations.
Even though it is fascinating as we are nearing a cure for HIV,certain questions are yet be answered in this child supposed to be cured from HIV.
1. Is it possible to confirm the HIV infection so early, that is within a day of the baby born?
2.As there is every possibility for the infected mother to give birth to an uninfected child without ART prophylaxis (nearly 60%), could this be one another child born free of HIV for an infected and untreated mother?
3.If this early treatment could be able to block the establishment of reservoir sites for HIV, why not an ART during intrauterine life block the reservoir sites in the baby as we are treating the antenatal mothers with HAART?
4.Is the establishment of reservoir sites for HIV developed only after birth of the baby?
If the investigators are able to through more light on these aspects it will be more useful for future developments.
Dr Murugan Sankarananthan
I agree that it is not that big a deal for HIV in the US. It just depends on your perspective. I treat HIV infected children in Central Africa, and I’m hoping this turns out to be a big deal for us.
Could this be seen as a case of Post exposure prophylaxis, with the exposure beeing the birth process?
I’m from Jackson MS and while I am always excited about anything that makes my state look good, when this story first hit, I wondered why the mediathought it was such a big deal. I think the early response of the dr involved showed she had the same initial reaction, although our med school will undoubtedly (and should) take the limelight for a while. Gosh knows, if something bad happens that’s not your fault, there will be blame, so it’s not unreasonable to take credit when there is an event that looks good whether it has any real affect or not.
But what this story shows as much as anything is the media’s inability to separate flash from substance in today’s immediate information age, a problem made worse by its disappointing lack of knowledge about anything medical or scientific.
It also shows the general public’s interest in and therefore willingness to support or fund certain issues or diseases that unfortunately have little impact when there are other issues on which those funds or public interest could make a real difference.
But the flashiest, squesky wheel gets the grease, and when you put the words HIV, cure and baby in one sentence, the media can’t wait to publish and the public can’t wait to believe.
I hope that this child portends a new treatment regimen or protocol for other infants in other parts of the world. If so, then we can put this right up there with the discovery of penicillin where doing something wrong (like leaving things exposed in the lab or in this case not taking medicine) have positive results.
But until SOME type of trial shows that this ANECDOTAL event can be repeated, then medicine will rightly put this event in the category of wait and see, while the media and the public lose interest and just sit back to wait for the next big thing.
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Can we really say that someone had an infection if there is no evidence of antibodies? With other viral infections such as measles, rubella, etc, once cured there are antibodies proving past infection. With this baby, it seems to me that it was exposed to HIV, but post exposure prophylaxis prevented infection from taking hold. Maybe if viral loads are performed on persons after high risk HIV exposures, the result would be positive! Maybe that should be a new study.