AIDS breakthrough 2. Baby released from HIV

Early drug treatment frees newborns from HIV

07/03/2014

Some progress has been made in the treatment of HIV in recent years. Now, for the second time, doctors have proven to be able to rescue a newborn baby from HIV, she says „New York Times“ in a recent post. Decisive for the success was as early as possible initiated, relatively high-dose drug treatment.

Last year, US scientists had the professional world at the „Conference on Retroviruses and Opportunistic Infections“ was surprised for the first time by the astounding news that an HIV-born baby could be cured only 30 hours after birth by the aggressive drug treatment with antiretroviral drugs. But there was a certain amount of skepticism. This year Dr. At the same conference, Audra Deveikis from the Miller Children's Hospital in Long Beach, California again reviewed a case in which a newborn child could be cleared of HIV by such drug therapy. The scientists also said there could be five more such cases in Canada and three in South Africa.

High-dose combination therapy frees newborns from HIV
The first healed HIV-infected child was known as Mississippi baby, is now over three years old and still free of viruses, reports the virologist Dr. med. Deborah Persaud, from the Johns Hopkins Children's Center in Baltimore, opposite the „New York Times“. The second baby is a girl who was born at the Miller Children's Hospital in Long Beach and whose mother suffers from advanced AIDS. The mentally ill mother had not taken her prescribed medicine, which should ensure a protection of the unborn child, which was why a high risk of infection was assumed. Already four hours after the birth Dr. Audra Deveikis therefore introduced a high-dose treatment based on the antiretroviral agents AZT, 3TC and nevirapine. Even before the examination of the blood sample taken was completed, the doctor began with the drug therapy. „I had heard of the Mississippi baby and knew that early treatment was important“, will Dr. Deveikis of the „New York Times“ cited.

Early treatment is crucial to success
The pediatrician explained that she was naturally concerned about the use of high-dose combination therapy, „but the mother's illness was not under control, and the risk of transmission was balanced against the toxicity of the drugs.“ The success proves the doctor right. Meanwhile, the girl is nine months old and free of HIV. The Director of the National Institute of Allergy and Infectious Diseases, dr. Anthony S. Fauci said that the well-documented case from Long Beach could lead to major changes. Because this is proof that successful therapy is possible if treatment is started early enough. So far, a preventive therapy for newborns with lower doses of two drugs has been performed until HIV infection could be confirmed by a blood test. Only with a proven HIV infection was the high-dose combination therapy, which should suppress the onset of the disease.

Possibly still dormant viruses in reservoirs
According to the doctors, the little girl is now housed in a foster home and in blood tests no HI viruses can be detected anymore. However, it is not quite right the baby as „healed“ Since, on the one hand, drug therapy is still taking place and, on the other, the virus may still be sleeping in hidden reservoirs of the cells, the doctors report. Theoretically, it would therefore be conceivable that with the discontinuation of the drugs, the HI viruses become active again. Therefore it is „medically unethical“ to discontinue the remedies now, Dr. Deveikis. However, the doctors claim to consider a temporary stop in therapy, when the baby is still free of viruses at the age of two, to see what happens.

Clinical trials planned for early HIV treatment
As physicians are currently planning a clinical trial with up to 60 HIV-infected babies to receive a combination therapy within 48 hours after birth. This is the final proof of the effect of early, high-dose therapy. However, even the case of the Long Beach baby already provides relatively convincing evidence for the success of the treatment, Dr. Steven Deeks, AIDS expert at the University of California at San Francisco opposite the „New York Times“ and added: „Therapy at birth seems to kill the virus before it becomes a permanent reservoir.“ Here, however, the question remains open as of when the treatment can be stopped or terminated. (Fp)

Picture: Katrin Schindler