The US National Institute of Health (NIH) is beginning a study to ascertain whether an aggressive treatment regime started soon after birth can effectively cure an infant of HIV. The global study is hoping to emulate the case of the ‘Mississippi baby’, who gained notoriety in 2013 after being functionally cured of HIV – a state where a very small amount of the virus is present, but is unable to replicate.
The Mississippi baby was given a strong dose of three antiretroviral drugs soon after birth, but its treatment stopped abruptly at 18 months when the mother was lost from care. When mother and baby returned to care five months later, the baby’s viral load was undetectable. Further tests found very small amounts of HIV in the body, but in a state of inactivity – three years later, the baby remains seemingly HIV free.
Scientists are baffled by this functional cure. The reason why HIV is so hard to cure is because of the formation of ‘viral reservoirs’ within cells – meaning that HIV can hide and remain dormant, protected from the attack of antiretroviral therapy. The researchers aim to assess whether or not the infants are born without these viral reservoirs, or if the viral reservoirs are simply more easily broken down by antiretroviral treatment during the first couple days of life.
The study will recruit 54 infants from 12 low, middle and high-income countries. It will take into account different prevention of mother-to-child transmission (PMTCT) strategies, including an arm for exclusive breastfeeding in low-resource settings and formula feeding in high resource settings. The babies will receive an aggressive drug regime for their first two years, their treatment will then be discontinued and they will be closely monitored for any rebound of the virus.
If this occurs they will restart their treatment immediately. Anthony Fauci of the NIH highlighted the importance of the study: “This would be a huge advance – that you could actually cure babies.” It could be a huge milestone, particularly in circumstances where, for whatever reason, mothers do not present to care, or do not know that they are living with HIV. Ultimately however, focus should still remain on increasing access to PMTCT services – which we know is highly effective and has meant that mother-to-child transmission has been virtually eliminated in many countries.