More than a year has passed since the last dose of antiretroviral drug treatment, or ART, was administered to the Mississippi toddler who continues to be deemed functionally cured of her HIV-1 infection.
The child was delivered premature at 35 weeks to a mother that had no documented prenatal care or treatment for the HIV-1 virus, for which she tested positive while in labor.
Though a Western blot test administered to the baby girl at birth showed the same positive result as her mother, within 30 days the virus was undetectable even through the most sensitive of tests.
Three years later, her viral load remains undetectable, possibly because she received rigorous treatment within 30 hours of exiting the womb.
“The big question, of course, is, ‘Is the child cured of HIV infection?’ The best answer at this moment is a definitive ‘maybe,’” Columbia University’s Medical Center scientist, Scott M. Hammer, wrote in an editorial on the case.
Hammer, who specializes in HIV studies and research, said “This uncertainty is due to the need for long-term follow-up while the child is not receiving ART.”
Hammer also said continued follow-up is needed because the human body has reservoirs where the virus can store itself, making its presence hard to measure and document through testing.
Nevertheless, hope has abounded in the science community, among those who are currently infected, and others looking to stop the epidemic that first took hold 30 years ago in North America.
A UNICEF report from 2012 found that roughly 330,000 new cases of HIV were found in children worldwide. That report was based off of 2011 data and counted children between birth and age 14. That same age group reported 230,000 deaths from AIDS.
“This case suggests that very early ART in infants may alter the establishment and long-term persistence of HIV-1 infection,” researchers wrote in the New England Journal of Medicine.
The Oct. 23 report is a follow-up on the initial details of the case, released in March at the Conference on Retroviruses and Opportunistic Infections in Atlanta by Dr. Deborah Persaud.
The latest report confirms that the child did test positive at the time of birth, and reiterates the fact that the child possessed an undetectable viral load—even after going off her prescribed treatment for reasons unknown.
“Between 18 and 23 months of age, the child missed several clinic visits,” said the report. “When the child was brought back for care at 23 months of age, the mother reported that ART had been discontinued when the child was 18 months of age, although pharmacy records indicated that the prescription was last refilled when the child was 15 months of age.”
“The child remains in care, and at the age of 36 months, at least 18 months after the cessation of ART, the child has no detectable level of HIV-1 RNA,” the report continued.
Aside from the rigorous ART given within 30 hours of birth, the child’s mother was also discouraged from breastfeeding; according to data from the Centers for Disease Control and Prevention, this is one way mothers transmit the disease to their children.
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