Baby with HIV “cured” – what does this mean for Africa?

Are we a step closer to finding a cure? In 2008, the first person Timothy Ray Brown known as “The Berlin Patient” was the first person reportedly “cured” of HIV. Six years on since having a series of complex medical procedures which included chemotherapy and a bone marrow transplant, he has no detectable levels of HIV.  Last week  the media was in a frenzy over a second possibly cured patient – this time a two year old child, dubbed the Mississippi baby.  The infant, now two and half years old needs no antiretroviral drugs.

The baby tested positive for the virus at birth. She became infected because the mother was not tested in early pregnancy and was not given antiretroviral treatment to prevent mother to child transmission (PMTCT).

By the time the doctors realised that the mother had HIV, it was too late for the normal PMTCT protocol so instead as soon as the baby was born, 30 hours after birth, she was given the full three antiretroviral drug combination as opposed to the single dose ARV drug normally given to babies. The baby continued treatment for 18 months then the baby and mother disappeared – which is referred as “lost to follow up”. However when the infant returned six months later, even though she had not been on treatment for six months,  when tested the infant was found to have an undetectable viral load.

Scientists refer to this as a “functional cure”- when people test negative for the virus but some of the virus has remained but is inactive. Normally babies treated with this drug complement stay on treatment but this mother never came back for more treatment so this unexpected event of the baby not continuing treatment is how the scientists derived their “functional cure”.

According to UNAIDS, there were 330 000 children newly infected with HIV in 2011.Every child born free of HIV a UNAIDS initiative reports only a third of infants in need of antiretroviral prophylaxis receive it.

Is this the big one? Do scientists have the cure? Unfortunately it is not as simple as that. What this “functional cure” does provide is exciting new areas for research. This one HIV-free baby may also be an exception to the rule. It is possible that this baby, for reasons unknown, may be different to other babies. More rigorous research is required before scientists can determine whether newborn babies can be treated in this way.  Furthermore this potential treatment may not work when HIV is discovered later, such as with adults.

What does this mean for Africa? Unfortunately with most new and improved treatments, developing countries are always the last ones to benefit. Odd, when they are places most in need. But do we really need a cure for babies with HIV if they are already effective methods of preventing transmission from mothers to children?

Dr. Mary Guinan writes in CNN

But there was another great advance against the HIV virus that did not make big headlines. A simple treatment with anti-retroviral drugs can prevent babies from being infected by their HIV positive mothers in the first place. Of course, a patient cure is much more visible than an infection prevented. Maybe that is why we celebrate cure in a way that we do not celebrate prevention”

But she also ends well by saying

…..let us celebrate each success. Each one gives hope that we will eventually conquer one of the most formidable of viruses.

 

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