The widely publicized case report regarding an infant in Mississippi who may have been cured of HIV infection after receiving very early antiretroviral therapy (ART) has now been published in the New England Journal of Medicine. The case was presented at CROI earlier this year and covered in detail on this blog at that time. The paper is largely based on the previously presented data, but provides a brief update in the discussion section: the infant is now 36 months of age and remains in care, having now been off ART for at least 18 months without any return of HIV RNA (an additional 8 months of follow up from the prior report). The journal publication is accompanied by an editorial commentary from Scott Hammer.
According to a Nature News article published back in June, the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Group is now planning a trial to assess whether the apparent cure achieved in this case can be duplicated in other children born to mothers who did not receive ART to prevent mother-to-child-transmission.
October 23, 2013DOI: 10.1056/NEJMoa1302976
Deborah Persaud, M.D., Hannah Gay, M.D., Carrie Ziemniak, M.S., Ya Hui Chen, B.A., Michael Piatak, Ph.D., Tae-Wook Chun, Ph.D., Matthew Strain, M.D., Ph.D., Douglas Richman, M.D., and Katherine Luzuriaga, M.D.
An infant born to a woman with human immunodeficiency virus type 1 (HIV-1) infection began receiving antiretroviral therapy (ART) 30 hours after birth owing to high-risk exposure. ART was continued when detection of HIV-1 DNA and RNA on repeat testing met the standard diagnostic criteria for infection. After therapy was discontinued (when the child was 18 months of age), levels of plasma HIV-1 RNA, proviral DNA in peripheral-blood mononuclear cells, and HIV-1 antibodies, as assessed by means of clinical assays, remained undetectable in the child through 30 months of age. This case suggests that very early ART in infants may alter the establishment and long-term persistence of HIV-1 infection.
October 23, 2013DOI: 10.1056/NEJMe1309006
Scott M. Hammer, M.D.