At the end of January the topic of the GMI blog was whether a cure was in sight for HIV. As I wrote then this is an area that is changing constantly as more research is conducted, drug trials are completed and our understanding of HIV is pushed forward. A few days ago a story was published of a baby from Mississippi who was seemingly cured of HIV. This week the blog explores this case and asks what it could mean for the hope of finding a cure for HIV on a larger scale.
What happened?
- The baby’s mother was HIV positive and this passed to the baby during pregnancy.
- Doctors decided to start the baby on anti-retroviral treatment less than 30 hours after it was born, much sooner than in most similar cases. Normally treatment is started after 6 weeks, once results from blood tests confirm the baby is HIV positive (see link).
- The baby’s viral count declined until HIV could no longer be detected after 29 days. The child now has no sign of infection, over 2 years after beginning treatment (see Huffington Post article).
- Treatment was stopped 1 year ago and there are no indications of infection.
- Researchers have been talking about a ‘functional cure’, rather than a technical cure for HIV. The virus has not been completely eradicated, rather it exists in such a low amount that the body is able to control it (4 copies of HIV DNA per million of white blood cells – see NHS article).
What are the hopes that this represents a cure for others?
The enthusiastic nature with which many doctors have commented on the case seems to imply that this case brings us closer than ever to finding a cure for HIV. Dr Rowena Johnston, of the Foundation for Aids Research, was extremely upbeat about the results of the approach used. In a BBC article on the case she commented ‘I actually do believe this is very exciting. This certainly is the first documented case that we can truly believe from all the testing that has been done. Many doctors in six different laboratories all applied different, very sophisticated tests trying to find HIV in this infant and nobody was able to find any’ . But what hope does this mean to others who are HIV positive or to those that are at risk of becoming positive?
Well, there are 33 million people worldwide with HIV and this is only the second reported cure (see the Berlin case for the other). In that respect the results of this case definitely appears to be groundbreaking. However, the NHS warns of reports of an HIV cure as premature. While it is possible the child could grow up with continued extremely low levels of the virus they could start to rise and antiretrovirals may be needed again in the future to control the virus. One thing appears certain – this approach must be replicated with other newborns to determine whether there is hope of using it in other cases. In terms of the transferability of this specific approach to HIV prevention it is important to recognise that in the vast majority of wealthy countries HIV positive mothers take antiretrovirals during pregnany, which significantly reduce HIV transmission, and prenatal testing is common to assess whether this is necessary. In the UK this prevents mother to child transmission in approximately 98% of cases. However, this approach definitely appears to be useful in the developing world where this approach is not as common and where mothers might discover they are HIV positive in labour, as was the case in this example.
Truvada, recently approved in the US for those at high risk of becoming HIV positive
What this case does show, quite clearly, is the potential value of using antiretrovirals (treatment) as a form of prevention. This, more general approach, is definitely something which is being trialled outside mother to child transmission cases, like the one above. For example after trials in the US, the government has recently approved truvada, as a form of pre-exposure prophlyaxis (Find out more about PrEP here) for high risk groups, such as men who are HIV negative and having unprotected anal sex. The idea with such treatment as prevention approaches is for medication to be taken by HIV negative people before they become infected with the virus. Nevertheless, using antiretrovirals to prevent HIV infection is an area that is seen by many in sexual health as controversial. Some worry that it takes the focus away from behavioural changes that can be taken to prevent HIV transmission, such as wearing condoms, which may be cheaper and have less health consequences. For example, there are concerns that taking truvada (used for PrEP) could result in drug resistance and make treatment of HIV infection much more problematic if the individual becomes HIV positive in the future, as highlighted by the ‘No Magic Pills’ website. While it is hard to deny that treatment as prevention offers great hope for finding a cure for HIV, it is a contentious issue and the possibility that it will become a widely used form of prevention still appears a long way off.
What do you think about treatment as prevention? Does treatment as prevention represent a viable approach? How close do you think we are to finding a cure for HIV?
GMI Partnership provide free HIV prevention services for men who have sex with men in London. For more information please contact tony@metrocentreonline.org
The views in the article above are those of the author and do not necessarily represent GMI Partnership.
