A second baby born with the AIDS virus may have had her infection put into remission and possibly cured by very early treatment -- in this instance, four hours after birth.
Doctors revealed the case Wednesday at an AIDS conference in Boston. The girl was born in suburban Los Angeles last April, a month after researchers announced the first case from Mississippi. That was a medical first that led doctors worldwide to rethink how fast and hard to treat infants born with HIV, and the California doctors followed that example.
In another AIDS-related development, scientists have modified genes in the blood cells of a dozen adults to help them resist HIV. The results give hope that this approach might one day free at least some people from needing medicines to keep HIV under control, a form of cure. That study was published in today's New England Journal of Medicine.
The Mississippi baby is now 31/2 and seems HIV-free, despite no treatment for about two years. The Los Angeles baby is still getting AIDS medicines, so the status of her infection is not as clear.
A host of sophisticated tests at multiple times suggest that the California baby has completely cleared the virus, said Deborah Persaud, the Johns Hopkins University physician who led the testing. The baby's signs are different from what doctors see in patients whose infections are merely suppressed by successful treatment, she said.
"We don't know if the baby is in remission, ... but it looks like that," said Yvonne Bryson, an infectious disease specialist at Mattel Children's Hospital UCLA, who consulted on the girl's care.
Doctors are cautious about suggesting she has been cured, "but that's obviously our hope," Dr. Bryson said.
Most HIV-infected moms in the United States get AIDS medicines during pregnancy, which greatly cuts the chances they will pass the virus to their babies. The Mississippi baby's mother received no prenatal care, and her HIV was discovered during labor. Doctors started the baby on treatment 30 hours after birth, even before tests could determine whether she was infected.
The California baby was born at Miller Children's Hospital Long Beach, and "we knew this mother from a previous pregnancy," and also knew she was not taking her HIV medicines, said Audra Deveikis, a pediatric infectious disease specialist at the hospital. The mother was given AIDS drugs during labor to try to prevent virus transmission, and Dr. Deveikis started the baby on them a few hours after birth. Tests later confirmed that she had been infected but does not appear to be now, nearly a year later. The baby is continuing treatment, is in foster care "and looking very healthy," Dr. Bryson said.
The Mississippi girl was treated until she was 18 months old, when doctors lost contact with her. Ten months later, when she returned, they could find no sign of infection, even though the mother had stopped giving her AIDS medicines.
The study in adults was prompted by an AIDS patient who appears cured after getting a cell transplant seven years ago in Berlin from a donor with natural immunity to the virus. Only about 1 percent of people have two copies of the gene that gives this protection, and researchers have been seeking a more practical way to get similar results.
HIV usually infects blood cells through a protein on their surface called CCR5. A California company, Sangamo BioSciences Inc., makes a treatment that can knock out a gene that makes CCR5.