HIV-Infected Infant Cured With Early Use of AIDS Drugs(bloomberg.com) |
HIV-Infected Infant Cured With Early Use of AIDS Drugs(bloomberg.com) |
I can't tell (from the relatively scant details) if the child ever developed HIV infection, by which I specifically mean to include infiltration of a cell by the virus, replication, and a host reaction. I can't find text in the articles describing which blood tests were done on the child. If her ELISA and Western blot are negative (still) but she initially had a nucleic acid amplification test that was positive with high titer, then it would make me wonder if the drugs, for this baby, were not necessarily the key element causing her to be disease free. I.e., I would wonder if the infant weren't actually cured because she was never fully infected in the first place.
If she was truly infected and her body was reacting to the replicated pathogen, then this early treatment strategy is extremely interesting.
How far we've come :)
See http://en.wikipedia.org/wiki/Ryan_White. There were competing social forces too.
I also remember as a kid the news when Magic johnson made his announcement and thinking , dam he is gonna die really soon, not knowing that decades later he is still doing well.
For example, those with HAART-treated HIV infection who have been treated for four years or more tend to die from a non-AIDS-related cause rather than from an AIDS-related one. [1]
My parents were scared out of their minds for my health whenever I went over to play (but they let me). They told me to never drink out of a dirty glass, never touch any blood, etc ... stuff that didn't make any sense to me at the time and a lot of stuff that's incorrect.
Anyway, AIDS meant sure death in those years.
I wonder if the kid has the CCR5-Δ32 mutation, which seems to provide natural immunity against certain strains of HIV.
http://www.guardian.co.uk/society/2013/mar/03/us-doctors-cur...
and New York Times article
http://www.nytimes.com/2013/03/04/health/for-first-time-baby...
just submitted to HN
http://news.ycombinator.com/item?id=5315660
http://news.ycombinator.com/item?id=5315673
make clear that this is a very unusual case. The baby's HIV infection was acquired from an infected mother, but her HIV status was not known until she was in labor. Because she did not receive the usual preventive treatment given to HIV-positive pregnant women, the baby received three-drug therapy rather than one-drug therapy as the baby's treatment began after birth. The baby's current status of no detectable infection after a hiatus in drug therapy is a very unusual outcome. It's unclear how likely it is that this result could be reproduced in other patients. Thousands of failures to attain the same outcome have already happened all around the world.
From the Bloomberg article submitted to open this thread:
"The baby, whose identity has been kept anonymous, began taking a regimen of AIDS drugs about 30 hours after she was born at a rural Mississippi hospital, doctors said today at a medical meeting in Atlanta. At 18 months, the mother took the child off the medication. With no signs of the virus for 10 months, the infant was deemed 'functionally cured,' researchers said.
. . . .
"The baby’s treatment combined lamivudine and zidovudine, both sold by GlaxoSmithKline Plc’s joint venture with Pfizer Inc., ViiV Healthcare, and Abbott Laboratories’ Kaletra."
From the New York Times article:
"If the report is confirmed, the child born in Mississippi would be only the second well-documented case of a cure in the world, giving a boost to research aimed at a cure, something that only a few years ago was thought to be virtually impossible.
"The first person cured was Timothy Brown, known as the 'Berlin patient,' a middle-aged man with leukemia who received a bone-marrow transplant from a donor genetically resistant to H.I.V. infection."
From the Guardian article:
"Children infected with HIV are given antiretroviral drugs with the intent to treat them for life, and Gay warned that anyone who takes the drugs must remain on them.
"'It is far too early for anyone to try stopping effective therapy just to see if the virus comes back,, she said."
AFTER EDIT: Following up on some of the other top-level comments here, gojomo asks how the case reported in this thread differs from Magic Johnson's condition. Magic Johnson has consistently taken his antiretroviral drugs, which were first developed only shortly before his HIV infection was diagnosed, throughout the decades since he was diagnosed. He has never had a hiatus in treatment. What's remarkable about the case reported today is that the baby's treatment was stopped at about age eighteen months, but the child still has no detectable HIV infection.
I remember all too well when AIDS was a sure death sentence. The development of effective antiretroviral drugs in the early 1990s was a huge surprise. Even today, there are very few drugs that are effective against any kind of viral infection (although there are many vaccines that kind prevent viral infections, and smallpox has been completely eliminated from humankind).
Another comment asked about cures for diseases announced in recent years. For the most part, reductions in disease risk are gradual, mostly from accumulation of better practice in treatment and prevention. But the death rate from all causes of death at all ages is steadily declining in the developed world,
http://www.scientificamerican.com/article.cfm?id=longevity-w...
and has been throughout my lifetime. For more than a century, humankind has been gaining life expectancy at the steady rate of fourth months per year (or one extra day of life for each day you live),
http://www.prb.org/Journalists/Webcasts/2010/humanlongevity....
http://www.demographic-challenge.com/files/downloads/2eb51e2...
http://www.pnas.org/content/105/36/13274.full
so a girl born in the last decade in the developed world has a better than even chance to living to age 100.
Does this mean that the virus could still be incubating in cells and some sort of stressor could cause the virus to come out, similar to those that have had Chicken Pox getting Shingles later in life? If so, is it really a cure? To me, a vaccine that has passed all trial stages and works almost 100% and w/few side effects is a cure. I don't want to belittle this miracle, but complacency caused by misleading news is much, much worse than playing it down and getting it right before announcing there is a cure. Hope is a wonderful thing though.
I am hoping for the best, it would a gift of life for millions, and drug cos can't hold this even if it cost them billions to make. Horrible PR and all.
However, could the virus still be there but under the test's threshold?
There was an excellent documentary released last year about the HIV/AIDS epidemic of the 80s and 90s, which I can't recommend highly enough. It's deeply interesting and eye-opening on several levels: http://surviveaplague.com/
Anyway, the doctors don't make any absolutely definitive statements, but:
"Now, after at least one year of taking no medicine, this child's blood remains free of virus even on the most sensitive tests available"
http://www.guardian.co.uk/society/2013/mar/03/us-doctors-cur...
True.
My point was that the title of the post indicated that the child was cured. We don't know that yet, and may not know for some time. It will be nearly impossible to eradicate HIV without prevention. If this child has unprotected sex as an adult thinking that it is cured, is that safe? We don't know. Maybe the virus will show again in their adulthood.
However, if a vaccine is found and we can prove the vaccination works, that provides a lot more security. Because of many of our parents getting vaccinated, Smallpox got to the point where their children (us) didn't have to get vaccinated. That is where we need to get with HIV. Because of AZT, etc. people just assume it is more of an annoyance now, like Herpes that can be managed. We need adequate resources dedicated and I am concerned that touting a cure that may not be is not in the public's best interest.
- Hepatitis B,
- Chicken Pox,
- HPV,
- Rotavirus,
- Hepatitis A,
- and Pneumococcal.
A lot of those simply got quietly introduced into the routine vaccination schedule for children and the diseases quietly vanished without much fanfare in those countries.
Polio is almost eliminated world-wide now, but that's taken decades.
http://www.cdc.gov/vaccines/pubs/vacc-timeline.htm
http://www.chop.edu/service/vaccine-education-center/vaccine...
Also, HIV is one of the few highly lethal epidemic diseases that continue to exist in the developed world so it receives a lot of attention, however a lot of progress is being made on other fronts.
For example, the HPV vaccine is a big deal, and should lead to a massive decrease of cervical cancers (largely caused by HPV infection). Also, the Varicella vaccine has been added to the standard "MMR" lineup (now MMRV). It's hard to get excited about wiping out "chickenpox" but the vaccine should reduce the incidence of deaths due to complications related to infection in children and especially in adults, as well as shingles and other illnesses related to infection. Rinderpest, a disease of cattle and some other ungulates, has been officially wiped out as of 2011. Additionally, several malaria vaccines are now in clinical trials. If they prove effective it could easily save millions of lives per year.
HIV mutates incredibly quickly, which makes it incredibly hard to find a "vaccine", because something that works against one strain probably won't work against the others. The same goes for treatments - most HIV patients have to take a various combinations of drugs (the slang term is their "cocktail") which vary in effectiveness both per-patient and over time.
Cancer is difficult for a different reason altogether: it's the body's own cells. To oversimplify, it's (relatively) easy to find a medicine that can target foreign cells, but it's hard to find a medicine that will target cancerous cells and not be equally deadly (or more deadly) to healthy cells, because cancerous cells so closely resemble healthy ones.
Progress is being made - just look at Bill Gates and his campaign for eradicating polio.
I was born in 1985, the year that AZT (the first effective anti-HIV drug) was patented, since then we've developed a whole spectrum of anti-retroviral drugs and turned HIV from a death sentence to an unpleasant chronic illness. The advances in anti hepatitis drugs are similarly enormous.
If you're over 20, then basically any non-generic drug sold in the US was developed in your life-time.
How to tell? Speak to any gay man who lived through the 80s and early 90s. In every reasonable sized gay ghetto, there were funerals every week for people dying of AIDS-related diseases.
Now there are far more treatment options: if one knows they've been exposed, a month-long PEP regimen can stop one from becoming HIV+.
Truvada has been approved by the FDA, which can reduce the risk of transmission by between 44% and 73% - this can be used to reduce the transmission rate for highly sexually-active MSM populations, and can also be a second line of defence for (both heterosexual and gay) HIV negative partners of HIV+ people (because condoms can break).
That there is new development on a possible route to reduce mother-infant transmission is exciting.
And the other day I saw this story - http://www.theatlantic.com/technology/archive/2013/02/could-... - redesigning needles could dramatically reduce transmission among IV drug users.
There won't be a grand announcement of "AIDS cured". What there will be is lots and lots of little things: improved public health messaging, improved drugs, more prophylaxis/vaccine research, lower prices for drugs and so on. We've come an enormous way already on HIV/AIDS. That there are people who were diagnosed in their 30s who are now living into their 60s or 70s is a huge improvement from people being diagnosed and dying within a year or two.
There might be if DRACO succeeds, and I would be surprised if some future medical advance doesn't cure it eventually.
Same for HIV.
HIV has a combination of latent virus and active viral expression at all times. It never goes entirely dormant because of its high replicative rate. You are correct that there is always some virus that is latent, however the overall infection will not assume latency without drug intervention.
This is as opposed to Varicella where the virus will go systemic latent and then reactive much later without any outside intervention.
Herpes is another viral infection that has true systemic latent periods where it is more or less hiding in your own DNA. It is periodically released and can then cause outbreaks of Herpes lesions such as cold sores on the mouth, genital lesions, etc.
The latency of all three diseases are why they cannot be cured once contracted. Varicella can now be effectively vaccinated against, and shingles can be avoided through boosters (not to mention avoidance of stress). One dream for curing HIV would be to signal all latent virus in the body to activate simultaneously, essentially causing a explosion of HIV viral particles, and then immediately flood the person with medication to wipe it all out. The problem with all DNA latency is how do you reach the virus, and if you can reach it, how do you reach it all at once to prevent the virus from reestablishing itself.
A patient on HIV medication can have undetectable viral load, meaning that all active virus is being suppressed. Stopping medication, even for 1 day, can lead to mutation and the rapid reestablishment of progression towards AIDS.
(After metastasis, the location is not important to understand the properties of the tumor, but it can affect the symptoms.)
(See also: http://en.wikipedia.org/wiki/P53)