Two children with HIV who were treated immediately after birth have no signs of the virus nine and 23 months later, scientists said in a report that suggests a potential approach to curing HIV-infected babies.
The findings from the two children are spurring doctors in Canada, South Africa and the U.S. to try to replicate the results, and spawned a study in 54 babies, the researchers said yesterday. The research suggests that deploying drugs early in life may help keep the virus from gaining a foothold. The importance of such a result is clear: More than 260,000 children were infected globally with HIV in 2012, either at birth or through breastfeeding.
While the early findings are promising, a final step is needed before determining that a cure is at hand, said Deborah Persaud, an associate professor of infectious diseases at the Johns Hopkins University School of Medicine in Baltimore.
"The only way we can prove that we've accomplished remission in these kids is taking them off treatment, and that's not without risks," Persaud, who was involved in the research on both babies, said in an interview yesterday at a medical meeting on infectious disease held in Boston.
While the latest HIV drugs can keep the virus in check, they don't eliminate it from hidden reservoirs deep within the body. The drugs are taken for a lifetime and patients often have to cycle among different medicines to offset the disease's ability to become resistant.
LOS ANGELES BABY
Persaud presented results yesterday from a child born last year in Los Angeles County. The baby began treatment with anti- HIV drugs four hours after being born and still has no trace of the virus in its blood, Persaud said. The baby remains on treatment, and there's no immediate plan to stop the medicine to see whether the virus rebounds, she said.
The previous child, born in Mississippi, was cleared of the virus with a similar approach a year ago, and remains HIV-free 23 months after ceasing treatment, according to Persaud, who presented her report yesterday at the annual Conference on Retroviruses and Opportunistic Infections.
Inspired by the Mississippi baby, doctors in Canada are now seeking to repeat the result in five newborns, and three babies in South Africa are also receiving medicines in an effort to cure them. Within the next few months, researchers also plan to start a trial in 54 children to test whether the approach can be repeated on a larger scale, Persaud said.
That larger study will start infected infants on treatment within 48 hours of birth, then take them off drugs two years later to see whether the virus rebounds.
DRUG COMBINATION
The babies will receive a three-drug combination of zidovudine and lamivudine, two now-generic medicines developed by GlaxoSmithKline Plc, and nevirapine, a treatment from Boehringer Ingelheim GmbH that has also lost patent protection.
The cases involving the two infants build on increasing evidence about approaches to curing a disease doctors once thought an insurmountable challenge.
To date, the only adult to have been cured of the virus is Timothy Ray Brown, the so-called Berlin patient. Brown has been clear of the virus since having a bone marrow transplant for leukemia in 2007 from a donor with a rare mutation to a gene called CCR5 that keeps HIV at bay without the aid of antiretroviral drugs.
While the case proves that HIV can be cured, bone marrow transplants are too expensive and dangerous to make them practical on a mass scale.
Sangamo Biosciences Inc. is trying to mimic the CCR5 mutation with a gene-altering technology. In a study published yesterday in the New England Journal of Medicine, researchers led by Carl June at the University of Pennsylvania infused 12 patients with Richmond, California-based Sangamo's SB-728-T, an experimental treatment that changes CCR5.
While the trial was designed to assess the product's safety, not its efficacy, it found that the treatment was associated with a drop in the amount of virus in some patients who were taken off their regular anti-AIDS drugs.
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