There has been a lot of media coverage lately regarding the toddler from Mississippi, who has been “cured of HIV.” Although this is excellent news, there are many nuances of this situation that are not being highlighted. The details of this case hardly resemble the average HIV infected person. That is why it is important to acknowledge the differences of this case study. At the 20th Conference on Retroviruses and Opportunistic Infections (CROI): Late-breaking abstract 48. Presented March 3, 2013, the subject was this child specifically.
The devil is in the details, so to speak. According to this article http://www.medscape.com/viewarticle/780397 , the premature infant was delivered via vaginal delivery from a mother, who was HIV positive. This mother never received prenatal care or antiretroviral medications for HIV. Second, the mother/child’s strain of HIV was not as aggressive as other strains and the mother did not have a high volume of virus in her system. Third, it is believed that the child became contaminated with the virus during the birth process. This would mean that the infection was almost immediate and medication was administered about 30 hours after birth. The virus did not have enough time replicating to do major harm to the immune system and cells associated with HIV infection. The medication itself may have prevented the virus from hiding out. Last, infants do not have T-cells, which act as hosts to the virus.
With all this known, one must now consider the term cure. The actual term is “functional cure.” This phrase means that the viral presence is so minimal that standard testing is unable to detect the virus. This infant actually received medication for 18 months and has been off the medication for 10 months. This child is thriving and that is great news for all.
The problem is that most HIV infections are not transmitted during the actual birth process. In fact, sexual intercourse accounts for most infections. Along with HIV transmission comes the long lapse of time from actual infection to discovery of HIV positive status. Time was an integral part of the infant’s situation.
The implications of this child’s functional cure are many. If mothers with HIV are recognized early, then could this medication regimen be instituted to infants at risk prenatally immediately after delivery? There are countries in Africa that report up to 30 percent of their women are HIV positive. Can antiretroviral medications be started immediately after one is exposed to the HIV infection? The war on HIV wages on but it is good to know that some battles are being won. Stay well.
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