In a medical first, a US baby born with HIV is now considered free from the infection thanks to aggressive and timely treatment using standard HIV drugs within hours after birth. It is now hoped that this ground-breaking case can be replicated for any newborn infected at birth.

The ‘miraculous’ treatment

The baby was born in a rural hospital in June 2010 after her mother was rushed to the emergency room in advanced labour. Only then did tests reveal that the mother was HIV positive. Since the mother had not received any prenatal antiretroviral drugs, the baby was highly susceptible to contracting the infection.

The infant was therefore transferred to another hospital where Dr Hannah Gay, a paediatric HIV specialist, initiated a full three-drug regimen consisting of AZT, lamivudine, and nevirapine instead of the usual milder treatment involving a single drug. The baby was then only 30 hours old.

Two separate blood tests done within the child’s first 48 hours of life confirmed the presence of the virus and the baby was kept on the full drug cocktail.

The baby’s immune system started responding after treatment and further blood tests revealed that the virus levels were declining until it was undetectable 29 days after birth. For undisclosed reasons, the mother stopped coming to appointments for about 10 months.

When the child came back, standard tests showed no trace of the virus and the tests for HIV-specific antibodies — the standard clinical indicator of HIV infection — also remained negative. The tests only found some genetic material remnants that do not appear to be able to replicate.

Viral reservoirs

HIV drugs are able to suppress the virus to an almost undetectable level but they do not cure the disease. That’s because the body has so-called ‘viral reservoirs’ which are cells where the HIV can remain dormant. However, as these virus cells are ‘hiding’, they can’t be killed by medicines and as soon as therapy is discontinued, the virus springs back to life and re-infects the person within weeks. In the baby’s case, researchers suspect that the prompt and intense dose of HIV drugs prevented the virus from forming hideouts in her body.

A functional cure

Experts warned that the baby was not completely cured but only ‘functionally cured’. This means that although standard tests are negative for the virus, it is likely that a very small amount remains but in levels low enough for the body to manage without the need for drugs.

Breastfeeding recommendations for infants born to HIV-positive mothers

HIV can be transmitted from the mother to her baby during conception, labour and delivery and via breastfeeding. As such, the NHS recommends that HIV infected women use the safe and widely available infant formulas to feed their baby.

The British HIV Association (BHIVA) further states that ‘a mother who is on effective triple-combination ART [antiretroviral drugs] with repeated undetectable viral load at the time of delivery may — after careful consideration — choose to exclusively breastfeed her baby for the first 6 months.’ The association warns that the woman should be frequently followed-up, her viral load monitored and, if required, supported by social services to ensure she adheres to medication.