This dormancy of the HIV virus is thought to have made possible by the rapid administration of antiretroviral therapy to the child almost immediately after birth.
This case is also unique because prophylactic (preventive) use of antiretroviral therapy to prevent transmission of HIV from mother to child was not required for the HIV virus to go into dormancy. Instead, the infant underwent remission of HIV infection after receiving antiretroviral therapy within 30 hours of birth.
From the information available we are informed that the child was born to a mother who presented in labour at a rural Mississippi hospital. The mother had not been in antenatal care so, as is normal in such a case, she was given a rapid HIV test to determine her status. The result was positive but due to a complicated delivery antiretroviral therapy was not administered to prevent transmission from mother to child.
The baby was transferred to the University Hospital at 30 hours old. Doctors then initiated triple prophylactic therapy and then transferred to highly active antiretroviral therapy (HAART) once the diagnosis was confirmed, via two separate positive tests.
The mother and child stopped attending when the child was 18 months and treatment was discontinued. They returned to the hospital when the child was 23 months. When tested the child was found to be HIV negative. This led to researchers carrying out a number of confirmatory tests to establish the result.
WHAT ARE THE IMPLICATIONS?
While this is a single case it presents an interesting concept to be further tested
that could lead to changes in the way infants who are infected at birth
are treated. The researchers believe that the aggressive treatment that
was initiated very early in the child’s life may have prevented the
establishment of latent ‘reservoirs’ and the subsequent replication of
the virus in the child. Reservoirs are ‘safe’ hideouts for the HIV virus
which makes it difficult to eliminate it even with good treatment, for
example in the fluid surrounding the brain.
Clinical trials for prompt antiretroviral therapy in infants are now in development through the IMPAACT network.
300,000 BABIES ARE BORN WITH HIV EVERY YEAR
The CROI conference was visibly excited about the science but the reality for HIV and antenatal programmes around the world is quite different.
- Every year more than 300,000 babies are born with the virus.
- Globally only 28% of children living with HIV in need of antiretroviral treatment are receiving it.
- In 2010, less than 50% of pregnant women with HIV got prophylactic antiretroviral therapy to prevent HIV.
Huge gaps also exist in regard to access to prevention of mother to
child (PMTCT) services such as supply of drugs and the availability of
trained staff to provide effective services. For instance, in Nigeria,
where an estimated 70,000 children are born with HIV every year, only
4.7% of antenatal facilities provide PMTCT services.
Despite an exciting moment in science, the translation of this to the
daily management of children born to women living with HIV around the
world is still a long way off.