Girl thought cured of HIV shown to have active virus

An infant who was seemingly cured of HIV following aggressive drug therapy just hours after her birth was recently discovered to be infected with the virus that causes AIDS after all, doctors announced Thursday.

The so-called Mississippi Baby, now nearly 4 years old, had raised hopes of a potential cure for babies infected with HIV when it was first described at an AIDS conference last year. The girl’s case also provided the foundation for an upcoming clinical trial.

The discovery recently that the 46-month-old child had actually carried the virus at undetectable levels for almost two years before it rebounded suddenly came as a blow to health officials and HIV experts.

“It felt very much like a punch to the gut,” said Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson who had treated the girl.

“It was extremely disappointing, both from the scientific standpoint that we had been very hopeful that this would lead to bigger and better things, but mainly for the sake of the child who now is back on medicine and expected to stay on medicine for a very long time,” Gay told reporters during a news conference.

The case of the Mississippi Baby had made international headlines.

Born prematurely to a mother infected with HIV, the infant was given a cocktail of three antiretroviral drugs 30 hours after birth. The baby remained on antiretroviral drugs for 18 months, after which the baby’s mother stopped taking her to see doctors and stopped administering the drugs.

Five months after that, doctors re-examined the child and found that even though antiretroviral treatment had been discontinued, her blood showed no detectable levels of HIV and no HIV-specific antibodies. Details of her case were published in October in the New England Journal of Medicine.

The child remained free of drugs and of detectable HIV for two years.

However, during a routine screening this month, doctors detected the virus in her blood, as well as a drop in her immune cells. After sequencing the virus, doctors determined it was identical to the one that had infected her mother – a finding that confirmed that the baby indeed had HIV at birth.

“There was some doubt as to whether the baby was infected,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in Bethesda, Maryland. “The baby clearly was infected.”

The case, the only one of its kind documented, has raised many questions about scientists’ understanding of the virus and may raise potential ethical issues regarding an upcoming clinical trial. The study is intended to determine whether children born to HIV-infected mothers can safely discontinue drug treatment if they show no signs of infection.

“There can still be persistent virus that can linger in a quiescent state that can come back at any time,” said Dr. Deborah Persaud, a professor of infectious diseases at Johns Hopkins Children’s Center in Baltimore.

“But the duration that this child has been off treatment really needs to be remembered here – 27 months of retroviral treatment,” said Persaud, who also worked on the girl’s case. “So there’s really still hope that a very early treatment strategy for perinatal infection can achieve longer remission in other perinatal infected infants.”

The girl was immediately given antiretroviral drugs after the virus was detected, dropping levels of the virus in her blood and increasing immune cell counts. “The child is having excellent response to the therapy that was started,” Gay said.