Doctors treating HIV/AIDS patients as well as scientists studying the virus are hopeful that an AIDS-free generation is on the horizon after a new case study was presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta, Georgia. But, there are skeptics.
In 2010, an expectant mother, who had recently tested positive for HIV, gave birth in a rural Mississippi hospital. The baby, whose identity has not been released, was a risk for infection of the virus because the mother did not receive prenatal treatment, including nevirapine, the drug typically given to HIV-infected mothers.
Physicians transferred the newborn to University of Mississippi Medical Center in Jackson, Mississippi, where Dr. Hannah Gay, a pediatric HIV specialist, treated the infant. After assuming the child was infected with HIV and within 30 hours of the infant’s birth, Dr. Gay decided to place the child an aggressive antiretroviral treatment instead of the typical prophylactic dose. In cases like this, the cocktail of three HIV-fighting drugs – zidovudine, lamivudine and nevirapine – is higher than normal.
Within three days of the child’s birth, test confirmed an HIV positive status. The infant’s immune system responded to the treatment and, after 29 days, the virus was not detected. For 18 months, the baby received treatment but it discontinued when the mother stopped bringing the child to appointments. The baby went untreated for about 10 months.
After locating the child, Dr. Gray ordered regular blood test to determine how to proceed with the antiviral treatment. However, detectible levels of the virus were not present; the child tested negative. The child underwent multiple highly sensitive polymerase chain reaction tests but HIV could not be identified.
Some researchers hypothesize that the aggressive cocktail prescribed to the infant prevented the virus from forming in viral reservoirs – hard-to-treat pools of cells where the virus is impervious to standard medication. Again, this is only a hypothesis.
The Mississippi baby, now two and a half years old, does not take antiviral medication and continues to test negative for HIV. Doctors describe the toddler as “functionally cure” but some experts do not think that the child was ever HIV positive.
“The one uncertainty is really definitive evidence that the child was indeed infected,” said Dr. Daniel R. Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital in Boston, Massachusetts.
Also, UNAIDS, while hopeful about the Mississippi case, thinks that more studies must be conducted to determine if the results are able to be duplicated.
Do you think that there will be an HIV/AIDS free generation? If so, when? If not, why?
“What role does skepticism play in scientific decision-making?” is Part 4 of our “On Being a Scientist” series, where we explore science within the context of society. Stay tuned for Part 5 of our series.
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