The second baby

Holy crap the HIV news last week!

So much HIV news!

First on the list:

Early Treatment Is Found to Clear H.I.V. in a 2nd Baby

Just in case you have forgotten, the first baby.

What happened to ‘the baby cured of HIV’?

Now, the second baby-- I must emphasize that I only know what has been reported to pop media. There is no publication associated with this second baby, yet. So I am going to operate under the assumption that Baby #2 was, in fact, infected with HIV, and not transiently exposed to HIV via Mom/anti-HIV antibodies from Mom/not really infected.

In this case, the mother was known to be HIV+, but due to a mental condition, did not take the appropriate anti-HIV drugs pre-birth. Again, Mom taking anti-retroviral drugs pre-birth has *drastically* reduced mother-to-child HIV transmission. But what if this safety net is not deployed? What if Mom does not know she is HIV+ (Baby #1), or does not take the meds (Baby #2)-- is there something physicians can do to save the baby from HIV infection after birth?

Hopefully!

Like Baby #1, Baby #2 was given HAART (a combination of three drugs) right after an HIV+ diagnosis at birth. This is a great idea-- though we think of HIV populations as being super crazy diverse, the fact is, usually only *one* genetic variant gets through to establish infection.

Unless that *one* genetic variant is drug resistant, giving three antiretrovirals at once could (should!) abort the infection.

This kind of approach could help a subset of HIV+ infants, if a number of hurdles are cleared (ability to test at birth, availability of immediate and persistent HAART, availability of alternatives to breast feeding/HIV- breast milk).

I dont know how many of the '250,000 babies born infected' will be able to clear those hurdles. According to the NYT article, '250,000 babies' are born infected with HIV... and fewer than 0.1% of them are in the US.

Saving 2 babies out of, 750,000 (250,000 x 3 years)... Unquestionably "YAY!" for those two kids, but dont fool yourselves. It is going to take a lot of work, a lot of education, and a lot of $$$$ to save the rest of them.

Just one thing I am worried about for Baby #2. Baby #1 being off the drugs was a fluke. An irresponsible parents did not fill the prescriptions. Baby #2 is still on the meds. Baby #2 should stay on the meds. Because all it takes is *one* latently infected cell reactivating for the entire enterprise to go down the toilet.

I tried to hide my confusion and anger at at Brigham and Womens Hospital physician telling his patients to stop taking their meds after they were functionally cured. But those patients were adults. Baby #2 is... a baby.

It is considered medically unethical to stop the baby’s drugs now, but Dr. Deveikis and Dr. Yvonne J. Bryson, a pediatric AIDS expert at the University of California, Los Angeles, who is also working on the case, said they would consider stopping them briefly to see what happens if the baby is still virus-free at age 2.

 

Dicking around with her meds 'just to see what happens'?

Baby #2 is a ward of the state.

No one should be taking Baby #2 off her meds.

Someone can talk to her about it when she is 18. Her physicians can talk about it if taking the drugs is endangering her life.

I better not read of anyone taking Baby #2 off her meds under any other circumstances, though.

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If it is very well monitored and done right, do we have any good reason to think that a single treatment interruption is very likely to be harmful, even if you see viral rebound (and aggressively suppress it, of course)? The risk of that needs to be assessed relative to prospect of life-long HAART, and I'm not sure it is as black and white as "only take her off HAART if it is endangering her life".

Really, if it appears that the baby is in fact HIV-negative, there might be "clinical equipoise" because HAART is not harmless, perhaps especially when taken from birth throughout development. One news story about this has reported that there may be quite a few similar babies in Canada. The story made it sound like Canada's general practice is to treat all babies of HIV-positive women as being AIDS patients and put them on triple therapy forever even if there is no evidence that they are actually infected - which many of them won't be. If so, certainly it's lifesaving - or at least life-extending - for most of those who are "really" infected, but let's not pretend that it won't do needless physical and emotional harm to those who aren't.