HIV: More 'Cures' in Babies?
Published: Mar 11, 2014 | Updated: Mar 11, 2014
Canadian scientists are studying a "handful" of children who have been treated for HIV within hours of their birth, a member of the research team said.
The cases are "very similar" to the so-calledMississippi baby, in that they all got full-scale triple HIV therapy in the first few hours of life, according to Hugo Soudeyns, PhD, of the Hôpital Saint-Justine in Montreal.
They are also similar, he said, in that very sensitive testing is finding little or no sign of HIV infection, Soudeyns told MedPage Today.
The major difference, however, is that all the children remain on antiretroviral therapy and there are no current plans to interrupt treatment, which Soudeyns said would raise "very serious ethical issues."
"Whenever you think about a functional cure, the ultimate proof would be to interrupt treatment," Soudeyns said. "For obvious reasons, this is something we are being very careful about."
Among other things, he said, the researchers are wary of raising hopes. "The whole field (of HIV cure) is based on a very few cases," he said, and none of them is a clear-cut definitive example.
In the now-famous Mississippi case, the child was treated 31 hours after she was born to a mother with uncontrolled HIV. The mother and child were lost to follow-up and when medical care was resumed, doctors found the baby had no sign of HIV infection despite several months off therapy.
The child, now 41 months old, remains HIV-negative and off medication, according toDeborah Persaud, MD, of Johns Hopkins University.
At the recent Conference on Retroviruses and Opportunistic Infections, Persaud reported that she and colleagues are now studying a second child, also treated within hours of birth, who appears to have no sign of HIV. That baby, now 9 months old, remains on treatment.
Soudeyns said the American researchers could have looked north at any time for still more cases, since standard care in Canada for several years has been to give newborns full-scale HIV therapy if they are born to mothers with uncontrolled HIV (unlike the U.S., where prophylaxis is favored).
While that happens rarely, the researchers know of at least five cases that are "potentially similar," according to their application for a research grant.
Soudeyns said they now prefer the less-specific term "handful" and are not releasing details such as the ages and sexes of the children pending a report planned for the Canadian Association for HIV Research meeting in May.
The goals of the study are to see if the early treatment leads to differences in the HIV reservoir, compared with children whose treatment started later, and to assess if there are any differences in their immune systems, Soudeyns said.
Persaud told MedPage Today that the Canadian cases are "exciting" and might add to the evidence that very early treatment can restrict the "dissemination" of HIV in infected newborns.
But she noted the Canadians will need to show that the children in their cohort were actually infected with HIV, not just exposed to the virus. And in the long run, she added, the proof of the benefit of very early therapy will be treatment cessation.
"We really have only one (baby) who's gone off treatment and has remained in viral remission," she said.
A clinical trial, with such treatment interruption built in as an endpoint, is in the planning stages, with the aim of answering questions about timing and follow-up of treatment cessation, as well seeing if the early therapy does in fact lead to lasting remission.
The Canadian researchers have $1.9 million (Canadian dollars, or $1.71 million in U.S. dollars) over 5 years from the Canadian Institutes of Health Research to carry out their study, which so far involves patients at three institutions -- the Hospital for Sick Children in Toronto, the Children's Hospital of Eastern Ontario in Ottawa, and Hôpital Sainte-Justine in Montreal.
But Soudeyns said he and colleagues are also working with all other pediatric HIV clinics in Canada and hope to find more cases.