HIV resurfaces in Mississippi baby many presumed cured

HIV resurfaces in Mississippi baby many presumed cured

So much excitement built around this idea that the U.S. National Institute of Allergy and Infectious Diseases (NIAID) announced plans in March to conduct a clinical trial in other newborns. Now, “we’re going to take a good hard look at the study and see if it needs any modification,” said NIAID’s director, Anthony Fauci, who spoke today with Gay and others at the teleconference. “We have a situation that’s obviously disappointing, but nonetheless there certainly are many confounding issues that arise and that will trigger intense discussion and further study, particularly with regard to the persistence of a reservoir in the absence of our ability to detect it. What has happened with this case is really quite important.”Steven Deeks, who conducts HIV cure research at the University of California, San Francisco, was surprised by the finding. “This virus is trickier than we thought,” Deeks said. “It drives home that we need even more supersensitive assays to detect a very little bit of virus. Or we’re going to have monitor these ‘clinically cured’ people for years.”Gay discovered that the virus had returned when the child came in for a routine checkup last week, which she does every 6 to 8 weeks. Two separate blood tests showed more than 10,000 copies of HIV per milliliter of her blood. The child last tested negative on ultrasensitive assays in April; another blood draw from June is being analyzed now. She began treatment immediately last week, and Gay says her patient is doing fine.In clinical studies of adults whose blood similarly tests negative for HIV, researchers often analyze more remote sites that can harbor reservoirs of virus, such as the lymph nodes, spinal fluid, or the gut. These tests typically are done before and after people decide to stop treatment. In the Mississippi case, the mother independently decided to stop treatment, so such before-and-after analyses were not warranted. “Obviously, this case highlights the need for that,” said Deborah Persaud, a pediatrician at the Johns Hopkins Children’s Center in Baltimore, Maryland, who headed the blood analyses and was lead author of the NEJM paper. “Further studies in the Mississippi child on antiretroviral treatment will help inform our [clinical trials] going forward.” Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Click to view the privacy policy. Required fields are indicated by an asterisk (*) Virus has returned in a child in Mississippi thought to have been cured of an HIV  infection, dashing hopes that scientists had found a strategy that would have widespread impact. After the girl went 27 months with no detectable virus in her blood, the sobering news “felt very much like a punch to the gut,” said her pediatrician, Hannah Gay of the University of Mississippi Medical Center in Jackson, who spoke at a media teleconference today.The “Mississippi baby” received international attention in March 2013 when Gay and her collaborators first reported the case. The baby was believed to be just the second person who had a documented HIV infection that appeared to have been cleared. The girl, now 46 months old, received unusually aggressive treatment with a cocktail of antiretroviral drugs 30 hours after birth to an HIV-infected mother. Typically, doctors give HIV-exposed neonates a single antiretroviral until they confirm the virus was transmitted, which take several weeks. Her mother stopped her daughter’s treatment at 18 months, which almost invariably leads to rapid return of the virus.As Gay and colleagues described in a detailed report that appeared in the 7 November 2013 issue of The New England Journal of Medicine (NEJM), ultrasensitive tests of the child’s blood done through 30 months of age found traces of HIV nucleic acid but no virus that could copy itself. The researchers  suggested that the early aggressive treatment may have limited the size of the HIV “reservoir”—the stubborn pool that remains in people who have undetectable levels of virus—or somehow left only crippled remnants of it that could not replicate. Sign up for our daily newsletter Get more great content like this delivered right to you! Country Email

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