A HIV born baby, who had appeared to have been cured of the virus following an antiretroviral treatment (ART), has been detected of HIV infection again.
The case report is the second report of apparent viral remission by rebound in a baby given early ART treatment, after the case of the 'Mississippi baby' received widespread attention in 2013-14.
A team of researchers, including Professor Mario Clerici at the University of Milan and the Don Gnocchi Foundation in Milan, Italy, reported that the baby, born to an HIV-positive mother in December 2009, appeared to have been cured of HIV at age three years, after intensive ART treatment was begun shortly after birth.
Tests to measure the amount of HIV in the child's blood (viral load) indicated that the virus had been eradicated. Notably, even antibodies to HIV had disappeared, showing that the baby was no longer seropositive and, with the agreement of the child's mother, ART was stopped.
However, two weeks later, the child's HIV tests came back positive, leading the researchers to conclude that the viral reservoirs had not been eliminated by ART, despite the virus being undetectable for more than 3 years.
There are differences between this case, and that of the Mississippi baby (as well as the 'Berlin patient' Timothy Ray Brown, thought to be the only adult to be cured of HIV); importantly, the child's immune system continued to show multiple signs of responding to HIV infection even after the viral load became undetectable, which was not the case for either the Mississippi baby or the Berlin patient.
The authors also suggested that the child's high viral load at birth, as well as an infection while in the womb, and low birth weight, may have also precluded long-lasting viral remission.
The case report concluded that the availability of many classes of potent antiretroviral drugs has substantially decreased HIV morbidity and mortality, but these drugs could not eradicate the virus because they did not eliminate viral reservoirs.
The case report is published in The Lancet.
