A 2½-year-old girl now joins the Berlin Patient as the second person “functionally cured” of AIDS. A functional cure is defined as the patient having no trace of the HIV virus in the body and off all medications.
Although no one is calling them cured, there are also dozens of people around the world who are no longer taking medications and are living normal, healthy lives despite the fact the virus is still in small amounts in their bodies.
The Mississippi Baby
The little girl received her cure through happenstance, but researchers are now looking at protocols to possibly change the way they treat pregnant mothers with HIV.
According to CNN, the girl was born to a mother who was HIV positive but had received no anti-viral care during pregnancy. They only discovered the mom had HIV just before delivery.
Currently, pregnant women take anti-viral drugs during pregnancy to prevent transmission to their child. While the children are born with HIV anti-bodies in only about 2% of cases do the children actually develop the virus. Since physicians did not have the opportunity to give the mom anti-virals they decided to dose the child instead.
30 hours after delivery the girl was dosed with antiretroviral drugs. Within a couple of days the child tested HIV positive. The child remained on HIV therapy for 15 months but then the mother stopped giving her the medication. Currently her blood work is coming back clean and after 15 months of no medication she was declared “functionally cured.”
The Berlin Patient
Timothy Ray Brown aka the “Berlin Patient” was the first person functionally cured of AIDS. Having the HIV infection, Brown also developed acute myeloid leukemia and needed a bone marrow transplant. Doctors in Germany were able to find a donor who is naturally immune to the HIV virus. About 1% of Caucasians have this “delta 32 mutation” that makes CD4 cells, a favorite target of the virus, impervous to HIV.
In mid-April this year, a 12-year-old Minnesota boy with both HIV and leukemia had the same procedure with marrow from a 1% donor. It will be months, however, before we know if the results will be similar to the Berlin patient.
The Visconti Cohort and the Boston Group
The Visconti cohort is a small group of 14 patients who were diagnosed early after the onset of HIV, were given antiretroviral drugs, and then were able to go off of the medication with no resurgence of the virus. These 14 patients, however, represent only about 15% of the patients who were able to stay off meds without a resurgence.
There is a similar research project at Mass General Hospital that takes patients through longer and longer periods of being off medication to create an “immune rescue” response. Some patients are able to go off medications completely.
A cure or is the virus in hiding?
For years, researchers have known that the HIV virus can go dormant (called provirus) in the body, hiding in “reservoirs” that can’t be detected until the virus becomes active at some point later in life.
The study, conducted at Howard Hughes Medical Institute (HHMI) and published in the journal Cell, found that 12 percent of proviruses are fully intact viral genomes and could become active at any time. To fully eradicate the HIV virus from a human these reservoirs would need to be addressed as well, and currently there’s not test to detect if they’re even there.
So are the Berlin Patient and the little girl cured? Could there be some dormant provirus hanging out somewhere in their bodies? The only way to confirm beyond a shadow of a doubt is with an autopsy.
According to Dr. Deborah Persaud, a virologist with Johns Hopkins Children’s Center and the lead author of the report on the baby, “Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place.”
Whether or not they are cured, time will tell. Brown has tested negative since 2006, the little girl for 22 months. The research shows there is more than one approach to taking patients from diagnoses to living well. As an M.D. or D.O. we will definitely be continuing this conversation inside Sermo, feel free to join your colleagues. Membership is free.