Researchers announced this week that a baby infected with HIV, or human immunodeficiency virus, is currently testing negative for the virus after aggressive drug treatments. The infant, born in Long Beach, California, in 2013, is the second such baby reportedly cured of the disease.
Both infants, one born in Mississippi in 2010 and the California baby, got HIV from their mothers, who were infected. Pediatricians attending the births decided to treat the newborns with a trio of drugs—as opposed to just two drugs—and at stronger than usual concentrations.
The early, aggressive treatments seem to have worked in both cases. The Mississippi baby—who stopped receiving treatment after 18 months—is now more than three years old, and tests have found no trace of the virus in the girl.
The California baby is on drug treatments but also seems to be free of the virus. The real test, experts say, will come when the California infant goes off the drugs. If she still tests negative for HIV, then she can be considered cured.
National Geographic interviewed Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, to find out what these developments mean for infants around the world who are infected with HIV.
They're some of the same drugs that you give to treat HIV infection [in adults]—that we've been using for quite a number of years.
Often, when babies are born, particularly from infected mothers that have not been treated, there's a high risk the baby is also infected.
Typically, pediatricians don't treat these high-risk babies immediately with all three drugs at regular levels. They'll give a preventive treatment—maybe two drugs at lower doses—test to see if the baby is truly infected, and if the baby is indeed infected, then switch to a more aggressive treatment.
[The California] baby was treated with a full three-drug regimen. After nine months, they couldn't find traces of virus in the baby. But the baby is still on the drugs. So they haven't proven that it's been cured. They have to take [the baby] off the drugs, and if there's no virus, then it's considered cured.
In the Mississippi case, the baby tested negative for HIV after going off the drugs. This indicates that early, aggressive treatment cured the Mississippi baby of HIV.
We're starting a clinical trial in May of babies that fall under the same circumstances and the babies will be followed over a period of years to see if [these results are] reproducible in a number of babies over years as opposed to just one or two.
How do these drugs work?
They just block the ability of the virus to replicate. [HIV] replicates within a cell, and there are multiple vulnerable points in that replication process that the drugs target. The three drugs target three different vulnerabilities in that replication cycle.
These drugs seem to eradicate HIV in babies, but not in adults. Why is that?
Because of the time that you start therapy related to the time you get infected. Most adults don't know they're infected for months, if not years. By the time they find out, the virus has been replicating for so long it can establish reservoirs in the body.
So even if an adult is treated with drugs, the virus can persist in the body thanks to those reservoirs.
Babies get infected usually at birth when they're coming through the birth canal. If you immediately treat the baby, you prevent the virus from spreading throughout the body. It doesn't have time to set up reservoirs.
How expensive is this treatment?
It's the same treatment we give to hundreds of thousands of people a year. It costs thousands of dollars a year in the developed world.
In developing countries the prices of the drugs are infinitely less expensive—about $150 a year—because the drugs are generics.
How long would it take to make this treatment standard practice?
It's probably going to take at least a few years to definitively prove that the treatment works and the benefits outweigh the risks of the drugs. If it turns out to be safe and effective, virtually every high-risk baby who is affected should be treated immediately.
Do you know when or if the California baby will be taken off the drugs?
No, I don't—and [the doctors are] going to have to sit down and talk about the risks and benefits of that. The first thing you want to do is do no harm. They'll probably be talking to ethicists and the families and other physicians. But it would be at least a year or two before stopping treatment.
Does it surprise you that these drugs are working so effectively in these babies?
No. I've been saying for a long time, that the earlier you treat the better. And if you treat within a few hours, that's as early as you can get.
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