One toddler’s parents were ecstatic when they were told that she no longer has HIV. But some time later the toddler’s physicians realized they were wrong. The toddler was and is still suffering from the difficult disease.

Reuters reports on the troubling story.

The baby initially made headlines last year when doctors thought she was one of the first to be completely cured through 30 hours of extremely aggressive treatment. The toddler’s parents brought her to a medical clinic for an annual blood test and the results showed traces of the HIV virus in her blood. More than 250,000 kids in the United States are diagnosed with HIV every year and researchers had initially thought that if this baby could be cured then there was great hope for the rest as well.

Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a press conference, “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.”

The toddler is now four years old. She was born to an HIV-infected mother who had received no prenatal care during her pregnancy. Dr. Hannah, a pediatric specialist, was the first to try to treat the baby’s infection. She offered the newborn a three-drug cocktail of strong HIV medications. During the course of normal standard of care, children suspected of HIV infection are usually given a milder course of treatments until tests can confirm that there actually is an infection.

The BBC explains the evolution of her medical condition, “She continued to receive treatment until 18 months old, when doctors could not locate her. When she returned 10 months later, no sign of infection was evident though her mother had not given her HIV medication in the interim. Repeated tests showed no detectable HIV virus until last week. Doctors do not yet know why the virus re-emerged.”

 The toddler was on this treatment regimen for around eighteen months, then stopped coming in for treatment. When she returned to the medical center some weeks later, the child showed no sign of the virus at all, therefore her doctors thought she was cured.

But all of that changed last week. “During a scheduled check-up last week, in which doctors discovered the virus had begun to replicate. The girl is now being treated with anti-HIV drugs, treatments she will likely need to take for the rest of her life unless a cure can be found. The developments likely cast doubt about the prospects of a cure for an HIV-infected California baby. In March, that child's doctors announced they had used the same approach and have found no trace of virus in the baby after nine months of treatment. Because that child is still being treated, however, the case was not classified as a cure,” according to Reuters.

Why or how did the virus come back all of a sudden?

Fox says, “Tests repeatedly showed no detectable HIV until last week, when copies of the virus were measured in her blood. Doctors say they don't know why the virus rebounded when it did, and said it raises profound questions about what they know about HIV's hideouts in the body.”

What does this mean for other kids with HIV? Despite the disappointing outcome the new development does show something important. It tells researchers that if children are given aggressive treatment then doctors can at least probably stop the virus from replicating.

The little girl is back on treatment and responding well. But do most kids contract HIV from moms who already have it? Is this common? Fox explains, “Most HIV-infected moms in the U.S. get AIDS medicines during pregnancy, which greatly cuts the chances they will pass the virus to their babies. This baby's mom received no prenatal care and her HIV was discovered during labor. Because of the baby's great risk of infection, doctors started her on unusually powerful treatment 30 hours after birth, even before tests could determine whether she was indeed infected.”

Therefore, just become a mom has HIV that does not mean her baby will necessarily get it.

Time magazine commented on the toddler's results saying, “Early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period.” 

The treatment plan was certainly helpful even though it did not cure the young girl.

Antiretroviral drugs can be tricky. There are many reasons why they may stop the disease from replicating initially but the effect does not last once treatment is discontinued. The BBC also reported on the little girl's condition and what type of treatment plan would be beneficial.

“Antiretroviral drugs can keep the virus in check in the bloodstream, but HIV has hiding places - known as reservoirs - in the gut and brain. If treatment stops, then the virus emerges from its reservoirs and begins its assault afresh. Doctors had hoped that starting drug treatment within hours of birth would prevent the reservoirs forming. This seems not to have been the case. The baby has become a reminder of how difficult HIV is to defeat and how distant a cure really is,” according to the BBC.

Has anyone ever been cured of HIV? “Only one other person is thought to have been cured of HIV infection - a San Francisco man who had a bone marrow transplant in 2007 from a donor with natural resistance to HIV,” according to Fox. He was tested five years after the treatment and still showed no sign of an HIV infection.  

Experts are particularly upset about this toddler’s case as it shows that there is still no actual cure for HIV in children who are innocently born with the disease. For the last year researchers had thought that this particularly aggressive treatment plan could work on children, but unfortunately that was not the case. However, this treatment plan will still be the dominant method of treatment for children as doctors and scientists find that it seems to prevent the disease from replicating, which is also extremely important.  

Gerry Oginski
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