HIV treatment for newborns nearing clinical trial

On April 23, 1984, Dr. Robert Gallo and a team of colleagues discovered that human immunodeficiency virus (HIV) contributed to individuals receiving auto immune deficiency syndrome (AIDS). As the 30th anniversary of this discovery took place this week, Dr. Gallo and fellow scientists claimed that two recent cases of apparently successful HIV/AIDS treatment on HIV-infected babies suggest that a functional HIV/AIDS cure may be in sight.

One prominent HIV case, which recently captured the attention of media outlets and scientists alike, concerns a baby girl born with HIV in Long Beach, Calif. The girl received high doses of three drugs — AZT, 3TC and nevirapine — four hours after she was born. Eleven days after, no traces of HIV could be found in the girl’s body, according to Dr. Deborah Persuad, the physician who led the testing.

When clinical researchers in Boston on March 5, 2014, for the annual AIDS conference  heard of the Long Beach baby case, they compared it to a similar case that occurred last fall in which doctors used aggressive drug treatment to make a Mississippi baby’s HIV go into remission. In response to these two cases, attendees of the AIDS conference announced their intention to hold a clinical trial to test 60 HIV-infected babies with the same prescriptions given to the Long Beach and Mississippi babies.

Prior to the clinical trial’s occurrence, some scientists are already convinced that the two recent HIV-cases serve as compelling evidence that using drug therapy virtually at birth can kill HIV before it establishes a permanent hold in the body.

Dr. Anthony Fauci, executive director of the National Institute for Allergy and Infectious Diseases, described the cases as “huge proof … that you can cure someone if you can treat them early enough.”

Other scientists are less optimistic, calling for more evidence that the two cases are not mere flukes. “We want to be very cautious here,” said Dr. Katherine Luzuriaga, an HIV/AIDS expert who helped treat the Mississippi baby. Instead of calling the case a complete success, Luzuriaga calls it a “remission because we’d like to observe the child for a longer time and be absolutely sure there’s no rebound.”

Skeptics also point out that even if HIV can be suppressed at birth, there remains no proof that similar drug therapy could be used to treat HIV-infected adults.

Dr. Gallo argues that even if a complete HIV cure cannot be found, it may not matter if scientists can learn how to prevent HIV from taking hold at birth or how to suppress HIV for the length of an average human lifespan.

“If you say to me [we have found] a virological cure — no virus left, no viral gene left in the body — this is extremely difficult. There are two reported cases in the world right now and, honestly, it’s not even possible to conclude in those cases, although it’s likely,” said Gallo.

“Now how about functional cure, where the person lives a completely normal life span? Even in the best-treated people today there’s some evidence for an increased incidence of some cancers like lymphoma. Let’s say we get rid of all those increased frequencies. And [patients] don’t ever have to take the medicine again. Is that achievable? And the answer to that is: I think so. If you say, ‘Put a date on it,’ I can’t. But you can see real possibilities because some of the drugs available now, and some that are just coming out, are truly, amazingly more efficient.”

If the upcoming HIV clinical trial affirms drug therapy’s usefulness in treating HIV at birth, it could benefit the approximately 250,000 babies born HIV-positive every year.

“Just the fact that we’re even mentioning the word ‘cure’ in terms of HIV is very exciting,” said Dr. Jeffrey T. Kirchner, director of the Comprehensive Care for HIV program at Lancaster General Hospital.

“It lends additional hope that people are working toward a cure for a disease that’s been around for 33 years now.”