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HIV rebounds in baby after 2 years with no ART
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The “Mississippi baby” who was thought to be cured of HIV and was reported in The New England Journal of Medicine last year now has detectable HIV after 2 years of not taking antiretroviral therapy, according to the clinicians and researchers involved with the case.
“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care and the HIV/AIDS research community,” National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said in a press release. “Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body. The NIH remains committed to moving forward with research on a cure for HIV infection.”
Anthony S. Fauci
The child was born prematurely to a mother who was not diagnosed with HIV until delivery and did not receive ART during pregnancy. At 30 hours of age, the infant began triple-drug ART and was confirmed to have HIV within several days. The child continued ART until 18 months of age when lost to treatment and stopped ART. When seen 5 months later, the child’s viral load was undetectable and remained undetectable for 2 years without ART.
Earlier this month, the 4-year-old child had a detectable viral load of 16,750 copies/mL during a routine clinical visit. A repeat viral load test 72 hours later revealed a viral load of 16,750 copies/mL. The child also had a decreased CD4 count. The child began ART again and is tolerating the treatment, which is decreasing the viral load.
“The fact that this child was able to remain off ART for 2 years and maintain quiescent virus for that length of time is unprecedented,” Deborah Persaud, MD, professor of infectious diseases at the Johns Hopkins Children’s Center, who is involved in analyzing the case, said in the press release. “Typically, when treatment is stopped, HIV levels rebound within weeks, not years.”
Fauci said that this case indicates that early ART did not completely eliminate the reservoir of HIV-infected cells that was established with infection, but perhaps limited its development and averted the need for medication for a longer period.
“Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged further,” Fauci said.