Mississippi baby

Last updated
Mississippi baby
BornSeptember 2010 (age 13)
Jackson, Mississippi, U.S.
Known forThought to have been cured of HIV

The Mississippi baby (born 2010) is a Mississippi girl who in 2013 was thought to have been cured of HIV. She had contracted HIV at birth from her HIV-positive mother. Thirty hours after the baby was born, she was treated with intense antiretroviral therapy. When the baby was about 18 months old, the mother did not bring the child in for scheduled examinations for the next five months. When the mother returned with the child, doctors expected to find high levels of HIV, but instead the HIV levels were undetectable. The Mississippi baby was thought to be the other person, after the "Berlin patient," to have been cured of HIV. As a result, the National Institutes of Health planned to conduct a worldwide study on aggressive antiretroviral treatment of newborn infants of mothers with HIV infections. It was thought that aggressive antiretroviral therapy on newborn infants might be a cure for HIV. On July 10, 2014, however, it was reported that the child was found to be infected with HIV. [1]

Contents

The worldwide study planned by the NIH continues in 2023 at 50 sites as clinical trial NCT02140255 under the same principal investigator. [2]

Background

In 2010, the "Mississippi baby" was a girl born by spontaneous vaginal delivery to an HIV infected mother at University of Mississippi Medical Center. The mother had received no prenatal care. During labor, the mother was tested for HIV and found to be positive. She gave birth to the baby before antiretroviral therapy could be delivered to prevent the transmission of HIV from the mother to the baby. When the baby was 30 hours old, Dr. Hannah Gay made the decision to begin aggressive antiretroviral therapy before the test results were available. [3] The baby was tested for HIV at 30 and 31 hours of age and found to be infected. [3] [4] [5] [6] [7] [8] [9] [10] Antiretroviral therapy was continued and the baby was tested at 6, 11, and 19 days of age. All three tests were positive for HIV. At age 29 days, she was tested again and HIV levels were found to have dropped below detectable levels. [7] [8] During the girl's first year, she was not breast fed and adherence by the mother to the antiretroviral therapy was determined by examining pharmacy records and by HIV testing. During this time, adherence to the therapy regimen was determined to be adequate. [5] [7]

At 18 months of age, there was concern about adherence to the therapy regimen, but HIV levels remained below detectable levels. Between 18 and 23 months of age, the infant missed all clinical visits and the mother reported that she had stopped the antiretroviral therapy when the child was 18 months old—normally therapy would not have been stopped. [11] The infant was tested and HIV levels were unexpectedly below detectable levels. Antiretroviral therapy was therefore not restarted. [3] [4] [5] [7] [8]

The mother of the Mississippi baby tested positive for HIV 24 months after delivery. She began antiretroviral therapy 26 months after delivery and was still positive for HIV 28 months after delivery. [5] [7] As of July 2014, the child was 46 months old. [12]

Reported cure

In October 2013, the physicians in charge of the Mississippi baby's antiretroviral therapy reported that at 30 months, 12 months after antiretroviral therapy stopped, HIV levels in the child were found to be below detectable levels. They first reported these results at 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta and subsequently published them in The New England Journal of Medicine . [8] Tests showed that the HIV DNA was still present but at levels similar to those in the only other person thought to be "functionally" cured of HIV (i.e., "control of viral replication and lack of rebound once they come off antiretroviral medications" [4] ), the "Berlin patient". [4] [5] [6] [7] [8]

Robert F. Siliciano hypothesized that the infant girl received antiretroviral therapy before producing memory T cells, which are immune cells that can serve as a viral reservoir for HIV. If treatment is received before they develop, there may be no place in the body for HIV to hide from antiretroviral drugs. [5] [10]

HIV re-emergence

On July 10, 2014, at a news conference held at the National Institutes of Health, health experts announced that detectable levels of HIV had been found in the child in tests conducted a week earlier. In two separate tests, they found that her blood levels of HIV had gone from undetectable to 10,000 copies of HIV per milliliter. [10] According to Anthony Fauci director of the National Institute of Allergy and Infectious Diseases, this result "is a disappointing turn of events for this young child, the medical staff involved in the child's care and the HIV/AIDS research community". [11] [12] Hannah Gay told NPR that the re-emergence of the virus "felt very much like a punch to the gut". [9] The Mississippi baby had been off her strong antiretroviral therapy for 27 months. Her HIV status was monitored every 6 to 8 weeks during that time with regular clinical visits. [9] [10] [11] [12] [13] [14] [15]

After her HIV status was confirmed by testing, she was placed back on antiretroviral therapy. By July 10, there were clinical indications that the therapy was working and reducing her viral load. [9] [10] [11] [13] [14] [15]

Analysis

If a mother is known to have HIV, she is given antiretroviral therapy during her pregnancy, which reduces the transmission of HIV to her baby to less than 2 percent (if a mother is untreated, transmission rates range from 15 to 45 percent). Although it is not common in the United States, some mothers do not know their HIV status and are not treated with antiretroviral therapy during pregnancy. [11] In 2011, 127 babies were born HIV positive in the United States, but an estimated 330,000 babies per year are infected at birth by HIV around the world. [4] [6] [8] [9] [12] [15]

Before the news of the re-emergence of the virus in the Mississippi baby, the National Institutes of Health had planned to conduct a worldwide study (using 17 hospitals in the US and hospitals in 11 other countries) of 54 infants that tested positive for HIV and to treat them with aggressive antiretroviral therapy within 48 hours after birth. If the infants subsequently had undetectable levels of HIV, the therapy would be stopped at 24 months. They would then be monitored for at least five years to see whether detectable levels of HIV re-emerged, as with HIV patients who stop taking their drugs. The study also planned to include two groups: infants breast fed by mothers who are receiving antiretroviral therapy and babies fed only infant formula. [6] Fauci stated that the planned study would likely continue, but modifications would be made. In particular, it is ethically unclear whether antiretroviral therapy should be stopped after 24 months to see whether viral loads rebound. [6] [9] [12] George J. Annas told NPR that he did not think that this aspect of the proposed study would pass "ethical muster". [9] [15]

As a result of the re-occurrence of the virus in the Mississippi baby, researchers are now asking whether fragments of the virus, which were still detectable, managed to recombine into a whole virus, or whether the virus managed to hide somewhere in the body that rendered it undetectable in testing. [12] One hypothesis had been that babies might be born without viral reservoirs in which the virus could hide. [6] Anthony Fauci told USA Today that it had long been hypothesized that a cure for HIV was possible "if you can get somebody treated before the reservoir of virus forms in the body, and before the immune system has been damaged by months or years of viral replication." [11] For instance, healthcare workers exposed to HIV immediately receive therapy, which almost always prevents infection by HIV. [11] [15]

Nevertheless, Deborah Persaud told USA Today that

The fact that this child was able to remain off anti-retroviral treatment for two years and maintain quiescent virus for that length of time is unprecedented. Typically, when treatment is stopped, HIV levels rebound within weeks, not years. [11]

Sarah Fidler of Imperial College London believes, despite the Mississippi baby setback, that early treatment could prevent the virus from taking hold. [3] Babies born of untreated HIV mothers become infected during the first hours of birth, and Fidler believes that effective treatment may have to begin within this brief window; this would require having antiretroviral drugs immediately available at the time of birth. [3]

There is a second baby infected with HIV in California who received antiretroviral therapy four hours after birth. [3] The baby will not be taken off antiretroviral drugs to determine whether she is cured for ethical reasons. As of July 2014, the baby was in foster care because her mother was in an advanced stage of AIDS. [15]

Related Research Articles

<span class="mw-page-title-main">HIV</span> Human retrovirus, cause of AIDS

The human immunodeficiency viruses (HIV) are two species of Lentivirus that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Without treatment, the average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype.

The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.

The spread of HIV/AIDS has affected millions of people worldwide; AIDS is considered a pandemic. The World Health Organization (WHO) estimated that in 2016 there were 36.7 million people worldwide living with HIV/AIDS, with 1.8 million new HIV infections per year and 1 million deaths due to AIDS. Misconceptions about HIV and AIDS arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that deny a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

<span class="mw-page-title-main">Nevirapine</span> Chemical compound

Nevirapine (NVP), sold under the brand name Viramune among others, is a medication used to treat and prevent HIV/AIDS, specifically HIV-1. It is generally recommended for use with other antiretroviral medications. It may be used to prevent mother to child spread during birth but is not recommended following other exposures. It is taken by mouth.

The Division of Acquired Immunodeficiency Syndrome (DAIDS) is a division of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health. It was formed in 1986 as a part of the initiative to address the national research needs created by the advent and spread of the HIV/AIDS epidemic. Specifically, the Division's mission is to increase basic knowledge of the pathogenesis, natural history, and transmission of HIV disease and to support research that promotes progress in its detection, treatment, and prevention. DAIDS accomplishes this through planning, implementing, managing, and evaluating programs in (1) fundamental basic research, (2) discovery and development of therapies for HIV infection and its complications, and (3) discovery and development of vaccines and other prevention strategies.

<span class="mw-page-title-main">HIV/AIDS</span> Spectrum of conditions caused by HIV infection

The human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. It can be managed with treatment. Without treatment it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS).

Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) co-infection is a multi-faceted, chronic condition that significantly impacts public health. According to the World Health Organization (WHO), 2 to 15% of those infected with HIV are also affected by HCV, increasing their risk of morbidity and mortality due to accelerated liver disease. The burden of co-infection is especially high in certain high-risk groups, such as intravenous drug users and men who have sex with men. These individuals who are HIV-positive are commonly co-infected with HCV due to shared routes of transmission including, but not limited to, exposure to HIV-positive blood, sexual intercourse, and passage of the Hepatitis C virus from mother to infant during childbirth.

<span class="mw-page-title-main">HIV/AIDS in Russia</span> Situation around HIV/AIDS in Russia

The situation with the spread of HIV/AIDS in Russia is described by some researchers as an epidemic. The first cases of human immunodeficiency virus infection were recorded in the USSR in 1985-1987. Patient zero is officially considered to be a military interpreter who worked in Tanzania in the early 1980s and was infected by a local man during sexual contact. After 1988—1989 Elista HIV outbreak, the disease became known to the general public and the first AIDS centers were established. In 1995-1996, the virus spread among injecting drug users (IDUs) and soon expanded throughout the country. By 2006, HIV had spread beyond the vulnerable IDU group, endangering their heterosexual partners and potentially the entire population.

Long-term nonprogressors (LTNPs), are individuals infected with HIV, who maintain a CD4 count greater than 500 without antiretroviral therapy with a detectable viral load. Many of these patients have been HIV positive for 30 years without progressing to the point of needing to take medication in order not to develop AIDS. They have been the subject of a great deal of research, since an understanding of their ability to control HIV infection may lead to the development of immune therapies or a therapeutic vaccine. The classification "Long-term non-progressor" is not permanent, because some patients in this category have gone on to develop AIDS.

<span class="mw-page-title-main">HIV/AIDS in Haiti</span>

With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk-factor groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission.

The Berlin patient is an anonymous person from Berlin, Germany, who was described in 1998 as exhibiting prolonged "post-treatment control" of HIV viral load after HIV treatments were interrupted.

<span class="mw-page-title-main">HIV/AIDS research</span> Field of immunology research

HIV/AIDS research includes all medical research that attempts to prevent, treat, or cure HIV/AIDS, as well as fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.

Deborah Persaud is a Guyanese-born American virologist who primarily works on HIV/AIDS at Johns Hopkins Children's Center.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in 2000 by Garnett et al. The term is often used to talk about treating people that are currently living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to prevent illness, death and transmission. Although some experts narrow this to only include preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners but also improve their current health to increase their lifespans. When taken correctly, ART is able to diminish the presence of the HIV virus in the bodily fluids of an infected person to a level of undetectability. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, as part of the HPTN 052 study, which shed light on the benefits of early treatment for HIV positive individuals.

<span class="mw-page-title-main">Neonatal infection</span> Human disease

Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or within the first four weeks of life. Neonatal infections may be contracted by mother to child transmission, in the birth canal during childbirth, or after birth. Neonatal infections may present soon after delivery, or take several weeks to show symptoms. Some neonatal infections such as HIV, hepatitis B, and malaria do not become apparent until much later. Signs and symptoms of infection may include respiratory distress, temperature instability, irritability, poor feeding, failure to thrive, persistent crying and skin rashes.

Viral load monitoring for HIV is the regular measurement of the viral load of individual HIV-positive people as part of their personal plan for treatment of HIV/AIDS. A count of the viral load is routine before the start of HIV treatment.

The Swiss Statement, or the Swiss Consensus Statement, was an announcement published in January 2008 by the Swiss Federal Commission for AIDS/HIV outlining the conditions under which an HIV-positive individual could be considered functionally noncontagious—namely, adherence to antiretroviral therapy, a sufficiently low viral load, and a lack of any other sexually transmitted diseases. While lacking the backing of complete, fully randomized clinical studies, the Commission felt the contemporary evidence for non-contagiousness for people on antiretroviral treatment was nonetheless strong enough to warrant official publication.

Undetectable = Untransmittable (U=U) is a message used in HIV campaigns. It means that if someone has an undetectable viral load, they cannot sexually transmit HIV to others. U=U is supported by numerous health groups and organisations worldwide, including the World Health Organization (WHO). The validity of U=U has been proven through many clinical trials involving thousands of couples. U=U is also used as an HIV prevention strategy: if someone is undetectable, they cannot pass it further and hence, prevent the virus from spreading. This is known as Treatment as Prevention (TasP).

References

  1. ↑ ""Mississippi Baby" Now Has Detectable HIV, Researchers Find". NIH. Retrieved 20 August 2014.
  2. ↑ "Very Early Intensive Treatment of HIV-Infected Infants to Achieve HIV Remission: A Phase I/II Proof of Concept Study". IMPAACT Network.
  3. 1 2 3 4 5 6 Boseley, Sarah (15 July 2014). "Kick and kill: is this the best new hope for an Aids cure?". The Guardian . Archived from the original on 15 July 2014. Retrieved 15 July 2014.
  4. 1 2 3 4 5 Knox, Richard (3 March 2013). "Scientists Report First Cure Of HIV In A Child, Say It's A Game-Changer". NPR. Archived from the original on 14 July 2014. Retrieved 14 July 2014.
  5. 1 2 3 4 5 6 Hayden, Erika Check (5 March 2013). "Infant's vanquished HIV leaves doctors puzzled". Nature . doi:10.1038/nature.2013.12531. S2CID   211728928 . Retrieved 15 July 2014.
  6. 1 2 3 4 5 6 Maron, Dina Fine (16 June 2014). "HIV on Trial: An Attempt to Cure the World's Smallest Patients: New global clinical trial aims to replicate the mysterious "Mississippi baby" success". Scientific American . Archived from the original on 20 July 2014. Retrieved 14 July 2014.
  7. 1 2 3 4 5 6 Persaud, Deborah; Gay, Hannah; Ziemniak, Carrie; Chen, Ya Hui; Piatak, Michael; Chun, Tae-Wook; Strain, Matthew; Richman, Douglas; Luzuriaga, Katherine (7 November 2013). "Absence of Detectable HIV-1 Viremia after Treatment Cessation in an Infant". The New England Journal of Medicine . 369 (19): 1828–1835. doi:10.1056/NEJMoa1302976. PMC   3954754 . PMID   24152233.
  8. 1 2 3 4 5 6 Young, Saundra (4 March 2013). "Researchers: Toddler cured of HIV". CNN . Archived from the original on 14 July 2014. Retrieved 14 July 2014.
  9. 1 2 3 4 5 6 7 Harris, Richard (10 July 2014). "Mississippi Child Thought Cured Of HIV Shows Signs Of Infection". NPR. Archived from the original on 15 July 2014. Retrieved 14 July 2014.
  10. 1 2 3 4 5 Chohen, Jon (10 July 2014). "HIV resurfaces in 'Mississippi baby' many presumed cured". Science News. Retrieved 14 July 2014.
  11. 1 2 3 4 5 6 7 8 Szabo, Liz (10 July 2014). "HIV infection returns in Mississippi girl thought cured". USA Today . Archived from the original on 13 July 2014. Retrieved 11 July 2014.
  12. 1 2 3 4 5 6 Maron, Dina Fine (10 July 2014). "HIV Detected in "Cured" Mississippi Baby, Creating Huge AIDS Therapy Setback". Scientific American . Archived from the original on 13 July 2014. Retrieved 14 July 2014.
  13. 1 2 Gallagher, James (10 July 2013). "HIV re-emerges in 'cured' Mississippi girl". BBC. Archived from the original on 14 July 2014. Retrieved 14 July 2014.
  14. 1 2 Ledford, Heidi (10 July 2014). "HIV rebound dashes hope of 'Mississippi baby' cure". Nature . doi:10.1038/nature.2014.15535. S2CID   196439703 . Retrieved 14 July 2014.
  15. 1 2 3 4 5 6 Mejia, Paula (13 July 2014). "Supposedly Cured H.I.V. Patient Still Has the Virus". Newsweek . Archived from the original on 15 July 2014. Retrieved 15 July 2014.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.