Mississippi Child Thought Cured Of HIV Shows Signs Of Infection

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Human immunodeficiency virus Type 1 inserts its genetic material into the DNA of human cells, turning them into little HIV factories. (Science Source)
Human immunodeficiency virus Type 1 inserts its genetic material into the DNA of human cells, turning them into little HIV factories. (Science Source)

A baby who generated great excitement last year because it appeared she had been cured of HIV is infected with the virus after all, health officials say.

This discovery is a setback for the child known as the "Mississippi baby." It also complicates efforts to test what had seemed like a promising new treatment for infants born with HIV.

The Mississippi baby was born to an HIV-positive mother in 2012. The mother had not received prenatal care, so wasn't identified as being positive for HIV until she was in labor. To stop the baby's infection, doctors tried an aggressive combination of drugs right after she was born.

Normally HIV-infected infants would stay on the antivirals for life. But in this case, the mother stopped bringing the child to the clinic after 18 months. When the two showed up again, five months later, the mother said she had long since stopped giving the baby medicine. But blood tests showed no signs of HIV infection.

Was it a cure? Hopes were high.

Thousands of babies are born to infected mothers every year, mostly in poor countries, and it would be wonderful if a strong dose of medicine at the time of birth could eradicate the virus from their bodies.

The news from Mississippi generated a lot of optimism. But Dr. Hannah Gay, who had treated the baby at the University of Mississippi Medical Center, remained on the lookout for HIV infection.

"Ever since we discovered this case in 2012, we've known that was a possibility," she said in a conference call yesterday.

The baby was not put back on anti-HIV drugs, but doctors kept checking her for signs of infection every six to eight weeks. More than two years elapsed with no sign of the virus.

"So, last week was one of those regularly scheduled visits," Gay said. "The child came; she had no abnormalities on physical exam."

But blood tests showed that the baby had an active HIV infection. The virus had emerged from some mysterious hiding place in her body.

"It felt very much like a punch to the gut," Gay said. "It was extremely disappointing."

"We had been very hopeful that this would lead to bigger and better things," she said. And she also is disappointed "for the sake of the child, who is now back on medicine and expected to stay on medicine for a very long time."

Based on the child's story, the National Institutes of Health had planned a huge study involving more than 700 other HIV-infected newborns. The strategy is to treat them with a powerful drug combination at birth and, assuming they show no signs of infection, take them off drugs altogether at the age of 2.

"The study is still in play," says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "But we're now just taking a close look at it ... to make sure that with the study we do it in an ethically sound way, and we get some answers to important questions."

But bioethicist George Annas, at Boston University's School of Public Health, says in his view this study will not pass ethical muster.

"To the extent that the justification for doing the trial is this one HIV-free child, and now it turns out that the child does have HIV, the trial should be stopped," he told NPR.

Annas says we have an extra ethical duty to children.

"We can't put them essentially in harm's way without some very good reason to think that they're going to benefit."

The study designers will have to grapple with that issue as they continue to look for ways to treat children facing a hard future with HIV infections.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Copyright NPR. View this article on npr.org.

Transcript

RENEE MONTAGNE, HOST:

It seemed like one of the biggest breakthroughs ever in the treatment of HIV when last year, a baby who had been born infected with HIV, appeared cured. The child had been treated with an unusually strong combination of drugs at birth and had shown no signs of infection, even after many months without drug treatment. But now, health officials say the baby is infected after all. NPR'S Richard Harris looks at the implications of this unhappy discovery.

RICHARD HARRIS, BYLINE: The girl is known simply as, The Mississippi Baby. Her mom was infected with HIV and she didn't get the standard drug treatment to prevent mother-to-child spread. Doctor Anthony Fauci at the National Institute of Allergy and Infectious Diseases, retold her story in a conference call yesterday.

ANTHONY FAUCI: The baby was treated with combination anti-viral retro therapy for 18 months and was then lost to follow-up.

HARRIS: Mom and baby just disappeared for five months and the baby stop getting medicine. When the mom eventually went back to the doctors, they tested the baby to see what had become of her HIV infection.

FAUCI: Upon examination, virus could not be detected in the baby.

HARRIS: Was it a cure? Hopes were high. Thousands of babies are born to infected mothers every year, mostly in poor countries, and it would be wonderful if a strong dose of medicine at the time of birth could eradicate the virus from their bodies. The news generated a lot of optimism. But Doctor Hannah Gay, who had treated the baby at the University of Mississippi Medical Center, remained on the lookout for HIV infection.

HANNAH GAY: Ever since we discovered this case in 2012, we've known that a return at some point was possibility.

HARRIS: The baby was not put back on anti-HIV drugs, but doctors kept checking her for signs of infection every six to eight weeks. More than two years elapsed with no sign of the virus.

GAY: So last week was one of those regularly scheduled visits. The child came, she was doing well, she had no abnormalities on physical exam.

HARRIS: But blood tests showed that the baby had an active HIV infection. The virus had emerged from some mysterious hiding place in her body.

GAY: It felt very much like a punch to the gut. Yes, it was extremely disappointing, both from the scientific standpoint - we have been very hopeful that this would lead to bigger and better things - but mainly for the sake of the child, who now is back on medicine and is expected to stay on medicine for a very long time.

HARRIS: Based on The Mississippi Baby's story, the National Institutes of Health planned a huge study involving more than 700 newborns with HIV which they were planning to treat aggressively at birth, and then after about two years, take them off drugs altogether. Dr. Fauci says, they haven't given up on that.

FAUCI: So the study is still in play, but we're now just taking a close look at it and getting all of the committees involved to take a real close look to make sure that with the study, we do it in a proper, ethically sound way and we get some answers to important questions.

HARRIS: But bioethicist George Annas at Boston University's School of Public Health says in his view, this study will not pass ethical muster.

GEORGE ANNAS: To the extent that the justification for doing the trials is this one HIV-free child - and now it turns out the child does have HIV - the trial should be stopped.

HARRIS: Annas says we have an extra ethical duty to children.

ANNAS: We can't put them essentially in harms way without very good reason to think that they're going to benefit.

HARRIS: The study designers will have to grapple with that issue, as they continue to look for ways to treat children facing a hard future with HIV infections. Richard Harris, NPR News.

MONTAGNE: NPR News. Transcript provided by NPR, Copyright NPR.