Do you all remember this story from last year?
I wrote about it a bit:
But it was hard to say much without a paper. As I was doing some other reading last week, I was like ‘Hey? What the heck happened to that baby? Surely they have a paper out by now!’ and they do:
Quick recap– Pregnant mom had no prenatal care. She came into the hospital to deliver. They did a quick HIV test, and she came up positive. Babby was born. Physician put babby on three different antiretroviral drugs ASAP. Mom quit filling babbys prescriptions at 15 months. Babby comes in to the hospital at 24 months… no HIV.
Babby cured of HIV??
As I said before, that wouldnt be unprecidented. When someone is infected with HIV, it is generally 1 (or very very few) different genotypes of virus. That one virus turns into a quasispecies (a huge population of viruses that are all related to one another, but each different from one another). By chance alone, there are individuals in the quasispecies that can escape every antiretroviral we throw at it, so, we cant cure people with drugs once the quasispecies develops.
If someone is infected with a non-drug-resistant form of HIV, AND we give that someone drugs (in this case, babby) BEFORE the quasispecies redevelops, then the treatment could knock out all the viruses.
In this case, it appeared to work.
This is unquestionably GREAT NEWS for babby, but how relevant is what happened here to the real world?
First, generally pregnant women are tested pre-birth for HIV. Giving Mom antiretrovirals right before birth has cut down on mother-to-child transmission of HIV *drastically* (exact percentages vary, but its <5% of HIV+ mom births). The women most likely to have access to these drugs? The women with money and access to adequate medical care.
Aggressive, multi-drug therapy wont help the women/babbies who dont even have access to the standard pre-birth medications– the babbies who would ‘need’ a more aggressive strategy the most.
Also, this babby was *not* breastfed. This is extremely important as that is another route where HIV can be transmitted mother-to-infant. And not breastfeeding was also important because it means babby got to take the drugs. If babby is breastfeeding, and Mom is on drugs too, babby can overdose. People who can afford formula are, again, not the babbies that would need this aggressive therapy the most.
This particular case is further complicated in that I think babby was infected in the womb, not during birth. At 31 hours after birth, the baby had a viral load of about 20,000 copies/ml. While that is not a huge number (I expect the number to be over 1,000,000 copies/ml during peak acute infection in adults), it is larger than what I would expect from, basically, one day of infection. But it is really hard to figure out what is going on without sequences of the viruses from Mom/babby, and they just arent in this paper. Why does that matter? The majority of infants infected with HIV are infected during birth. Shorter infection means less diversification within the quasispecies, meaning they might get the same benefit with fewer drugs (one drug vs three).
So again, seemingly curing this baby of HIV infection is flat out fantastic. But this approach will pretty much only help the kids that should have been helped by an alternative approach, but didnt because of access to meds, and this approach requires even more meds. And formula.
What this incident reemphasizes what we already knew– people need access to antiretrovirals. As soon as possible after infection. Not when their CD4+ numbers drop. Now*.
* But Im just saying this for the Benjamins.