Toddler With HIV Is Cured—So What’s Next?

In a landmark announcement, researchers said they'd cured the first child with HIV, the virus that causes AIDS. The 26-month-old toddler was born to a mother also infected with the virus, and was started on combination antiretroviral treatment (ART) when she was just 30 hours old. A press release issued by Johns Hopkins University School of Medicine, home to Deborah Persaud, Ph.D., a virologist and the study's lead author, said the news "may help pave the way to eliminating HIV infection in children."

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The announcement of the case was presented in Atlanta at a conference on retroviruses and opportunistic infections. The researchers called the finding a "functional cure," which means that a patient shows remission of the virus over a long period of time without treatment and that tests can't detect HIV replication in the blood.

Karin Nielsen, M.D., M.P.H., a clinical professor of pediatric infectious diseases at the University of California, Los Angeles, calls the announcement "exciting news."  What seems to be most important about how this little girl was cured was when her treatment started: She began ART very soon after birth, which seems to have prevented what HIV/AIDS specialists call a "latent reservoir" where dormant HIV cells can hide, making them hard to treat and allowing for the infection to start up again once treatment stops. "Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place," said Persaud in a press release.

Adds Nielsen, who was not involved in the study, says the news supports "the hypothesis that many of us who work in perinatal/ pediatric HIV suspected—that early treatment with antiretrovirals can not only prevent or abort infection, but also impede seeding of reservoirs and revert what seems to have been an established infection," she explains. "If these findings are reproduced in further studies this could definitely change the HIV treatment paradigm in early infant infection, with the emphasis being 'treat to cure.' "

The child continued to receive treatment and by the time she was 29 days old the virus could no longer be detected in her blood. The study's authors say she continued treatment until she was 18 months old, then, for unknown reasons, stopped. Ten months later, she was tested again and the doctors could not find any trace of HIV or HIV-specific antibodies.

The current standard care for babies at risk for acquiring HIV is to give them a lower dose of combination ART for six weeks to prevent infection and continue with a therapeutic dose if an infection is found. But standard treatment may start to change as the result of this watershed case. "These findings will lead to studies of very early treatment in HIV-exposed infants at high risk of infection," notes Nielsen. "If further research confirms that early treatment reverts HIV infection in infants, early intense treatment of infected babies will likely become standard of care."

And is there anything in the announcement that might help HIV-infected adults—could they, too, benefit from very early treatment, right after infection? "Early intense treatment can be instituted, which is something that has been done in selected studies," Nielsen explains. "Cure, however has not been observed to date." The reasons may have to do with the timing of therapy, how the virus was acquired, or other factors that are different between adults and babies, she says. "Nevertheless, if the infant cure findings are duplicated, they serve as a model for achievement of a functional cure which can potentially be extrapolated to adults once details on the pathogenesis are better understood." And that's something to hope for and work toward—for infants, children, and adults.