‘Mississippi Baby’ now has detectable HIV

The child known as the “Mississippi baby” — an
infant seemingly cured of HIV that was reported
as a case study of a prolonged remission of HIV
infection in The New England Journal of Medicine
last fall — now has detectable levels of HIV after
more than two years of not taking antiretroviral
therapy without evidence of virus, according to
the pediatric HIV specialist and researchers
involved in the case.
“Certainly, this is a disappointing turn of events
for this young child, the medical staff involved in
the child’s care, and the HIV/AIDS research
community,” said NIAID Director Anthony S.
Fauci, M.D. “Scientifically, this development
reminds us that we still have much more to
learn about the intricacies of HIV infection and
where the virus hides in the body. The NIH
remains committed to moving forward with
research on a cure for HIV infection.”
NIAID and the Eunice Kennedy Shriver National
Institute of Child Health and Human
Development, both part of the National Institutes
of Health, provided funding to the researchers
involved in the analysis of the case and will
conduct a clinical trial to build upon the findings.
The researchers planning the clinical trial will
now need to take this new development into
account.
The child was born prematurely in a Mississippi
clinic in 2010 to an HIV-infected mother who did
not receive antiretroviral medication during
pregnancy and was not diagnosed with HIV
infection until the time of delivery. Because of
the high risk of HIV exposure, the infant was
started at 30 hours of age on liquid, triple-drug
antiretroviral treatment. Testing confirmed within
several days that the baby had been infected
with HIV. At two weeks of age, the baby was
discharged from the hospital and continued on
liquid antiretroviral therapy.
The baby continued on antiretroviral treatment
until 18 months of age, when the child was lost
to follow up and no longer received treatment.
Yet, when the child was again seen by medical
staff five months later, blood samples revealed
undetectable HIV levels (less than 20 copies of
HIV per millilitre of blood (copies/mL)) and no
HIV-specific antibodies. The child continued to
do well in the absence of antiretroviral medicines
and was free of detectable HIV for more than two
years.
However, during a routine clinical care visit
earlier this month, the child, now nearly 4 years
of age, was found to have detectable HIV levels
in the blood (16,750 copies/mL). Repeat viral
load blood testing performed 72 hours later
confirmed this finding (10,564 copies/mL of
virus). Additionally, the child had decreased
levels of CD4+ T-cells, a key component of a
normal immune system, and the presence of HIV
antibodies — signals of an actively replicating
pool of virus in the body. Based on these results,
the child was again started on antiretroviral
therapy. To date, the child is tolerating the
medication with no side effects and treatment is
decreasing virus levels. Genetic sequencing of
the virus indicated that the child’s HIV infection
was the same strain acquired from the mother.
The child continues to receive medical care,
treatment and monitoring from Hannah Gay,
M.D., a paediatric HIV specialist at the University
of Mississippi Medical Centre in Jackson, who
has been involved in the child’s care since birth.
In light of the new findings, researchers must
now work to better understand what enabled the
child to remain off treatment for more than two
years without detectable virus or measurable
immunologic response and what might be done
to extend the period of sustained HIV remission
in the absence of antiretroviral therapy.