Published March 04, 2013
The medical community is celebrating today, as scientists from Johns Hopkins Children’s Center and the University of Mississippi have announced a case in which a Mississippi baby born with HIV has seemingly been ‘cured’ of the disease.
According to researchers, the child – who is now 2 ½ – has been off HIV medications for a year and does not show any sign of infection. If the baby remains healthy and in remission, this would be the second ever report of an HIV cure.
Using a much more aggressive treatment than usual, Dr. Hannah Gray, a pediatric specialist at the University of Mississippi, started the baby on a three-drug infusion within 30 hours of birth. This fast therapy apparently eradicated the HIV from the child’s blood before it could form reservoirs of dormant cells in the body.
So what does all of this mean for the future of HIV treatment? Will this news change the way doctors treat at-risk babies moving forward? Dr. Manny Alvarez, senior managing health editor for FoxNews.com, spoke with Dr. Julia Piwoz, chief section of pediatric infectious diseases at the Joseph M. Sanzari Children’s Hospital about the current state of HIV transmission in pregnant mothers and how this medical breakthrough may change the medical landscape – or not.
What is the current treatment for HIV and pregnant mothers?
Dr. Piwoz: “For HIV in pregnancy, women are treated really regardless of their disease state. Expectant mothers are typically treated with three medications. Which medicines they receive depends on what medicines they’ve been on in the past and certain things like the type of virus they have or what it’s sensitive to. That’s determined by their infectious disease specialist.
“There are several different medications available, and if someone is on a stable medicine regimen before they get pregnant, their doctor may choose to continue that regimen throughout pregnancy. If a woman is diagnosed during pregnancy, then their HIV specialist will put them on a “cocktail” of three really active highly active anti-retro viral treatment (what we refer to as HAART).
“Depending on certain things like the mom’s health, her level of virus, and her T-cell counts, we’ll determine how she delivers – whether by C-section, or if she’s very healthy, whether or not she’ll be a candidate for vaginal delivery. Mom’s also receive a course of intravenous medication prior to delivery.
“Infants who are born to women who are known to be infected with HIV are given a six week course of the medication called Zidovudine, formerly known as AZT. If a mother shows up when her status is not known, and she shows up in labor, other medications such as Nevirapine may be given to the baby.”
What is the rate of HIV transmission between mother and child?
Dr. Piwoz: “If no treatment is given, and mom is on no medication at all, her risk of transmitting to her baby is about one in four. If she is treated during her pregnancy and maintains her health and comes in and gets the intravenous medication, then the transmission rate can be less than 2 percent – or even 1 percent, as long as we know who’s infected.
“There are even regimens to show that treatment later in pregnancy still helps. Even at the time of delivery, we can still cut transmission significantly by giving meds to the baby and ensuring the baby doesn’t breast feed.”
Do you think this breakthrough treatment will become the gold standard for HIV positive children?
Dr. Piwoz: “Not exactly and here’s why: In the state of New Jersey, we perform HIV testing on all pregnant women in the first and third trimester. If they come in without a test, we do a rapid test. The majority of HIV transmission from mother to baby happens at the time of labor and delivery. If we’ve treated mom during the pregnancy and she’s responded to treatment, then her risk of transmission to the baby is very low and the baby’s risk might not justify such aggressive treatment.
“What it may change is how we test and treat women who were not treated during pregnancy. Normally the current recommendation is to do testing by DNA PCR – which tests for the virus in the cells – and then putting the baby on one medication and adding the second medication Nevirapine for three doses. How this might change high-risk babies, when they’re born we may send a test called RNA PCR – which tests for virus in the plasma. And we might consider more aggressive treatment in infants who are at high risk.”
Where do you see the future of HIV treatment going?
Dr. Piwoz: “I think that when it comes to HIV, we’ve gone from having very few medications to having more than 30. I think that over time, our medications have become easier to take and less toxic, and people are living longer, healthier lives. I think that those infected will continue to benefit, and in general, we are seeing fewer and fewer babies being born with infection.
“We can prevent mom from passing HIV to her baby if we know which moms are infected, and many states have adopted the Centers for Disease Control and Prevention’s recommendation to test all pregnant women. One area where we still see infections is in teenagers, so if we can reduce those infections, we’ll have fewer babies being infected with HIV.
“And with other countries, even some of the poorer countries have started providing access to HAART and started using some of the regimens to prevent maternal transmission – and they have been successful. If they can provide the proper money and infrastructure, we’ll start seeing fewer moms being sick, fewer babies being sick, and fewer orphans.
“So we are starting to see benefits all over the world.”