Doctors now have convincing evidence that they put HIV into remission, hopefully for good, in a Mississippi baby born with the AIDS virus — a medical first that is prompting a new look at how hard and fast such cases should be treated.
The case was reported earlier this year but some doctors were skeptical that the baby was really infected rather than testing positive because of exposure to the virus in the mom's blood.
The new report, published online Wednesday by the New England Journal of Medicine, makes clear that the girl, now 3, was infected in the womb. She was treated unusually aggressively and shows no active infection despite stopping AIDS medicines 18 months ago.
Doctors won't call it a cure because they don't know what proof or how much time is needed to declare someone free of HIV infection, long feared to be permanent.
“We want to be very cautious here. We're calling it remission because we'd like to observe the child for a longer time and be absolutely sure there's no rebound,” said Dr. Katherine Luzuriaga, a University of Massachusetts AIDS expert involved in the baby's care.
The government's top AIDS scientist, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, agreed.
“At minimum, the baby is in a clear remission. It is possible that the baby has actually been cured. We don't have a definition for cure as we do for certain cancers, where after five years or so you can be relatively certain the person is not going to go and relapse,” he said. A scientist at his institute did sophisticated tests that showed no active virus in the child.
A government-sponsored international study starting in January aims to test early treatment in babies born with HIV to see if the results in this case can be reproduced.
Only one other person is thought to have been cured of HIV infection — a San Francisco man who had a bone marrow transplant in 2007 from a donor with natural resistance to HIV, and showed no sign of infection five years later.
In the Mississippi baby, “there's no immune mechanism we can identify that would keep the virus in check” like that bone marrow donor, said another report author, Dr. Deborah Persaud of the Johns Hopkins Children's Center, who helped investigate the case because she has researched treatment in children.
In the coming study, doctors plan to give AIDS medicines for at least two years and watch for signs of remission before suspending treatment and seeing whether a remission results.
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