Researchers reported a case of a “functional cure” of a small child on Monday at the 2013 Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta. Dr. Deborah Persaud from Johns Hopkins University explained that a child, who appeared to be infected 30 hours after birth, and started on antiretroviral (ARV) therapy, has now been off therapy for roughly 12 months without the return of virus.
The child’s HIV status was confirmed at 30 and 31 hours with both a DNA and an RNA test and at this time point it had nearly 20,000 copies of HIV in blood. Dr. Persaud explained that when children have virus at this early state it is strongly assumed that the baby was infected before the birth process. The child was started immediately on a prophylactic regimen of ARVs and once infection was confirmed switched to a treatment regimen including lopinavir/ritonavir (Kaletra). The child remained on treatment until 18 months of age, at which point the child’s guardian withdrew treatment and disappeared from care.
Case workers tracked down the child several months later and the baby reentered care at 23 months. At that time point viral load tests and an antibody test were performed. The viral load test was undetectable and the antibody test was negative. The baby had remained off of therapy since. Subsequent analysis revealed small traces of HIV DNA in cells taken from the blood.
Dr. Persaud, during her presentation, stated that while the available evidence suggested a “functional cure,” there is still a chance that the baby’s virus will return eventually.
During the session, one researcher complained about the term “functional cure”, because in adults this usually is accompanied by detectable immune cells that are strongly oriented toward recognizing and killing HIV. In this case, the baby has none of those cells. Another presentation earlier in the conference also suggested that when the viral reservoir is reduced to a very small size, but not eliminated, it could result in the virus remaining undetectable in blood for many months before climbing again.
In subsequent conversations with researchers and activists after the session, they expressed some skepticism that a functional cure can ever be resolutely proved in this case, in part, because lingering questions will remain about whether the baby was ever truly productively infected with HIV before clearing most of the virus without the need for ARV control. There was also some consternation about announcing this a cure of any type at this early time point.
Nevertheless, this is an encouraging case report and further cases are now being sought and discussions are beginning on how best to test the theory that very early therapy in infants may result in a cure of some kind.