This week the scientific community was abuzz with the news of the first child to be cured of AIDS. A baby born in Mississippi with the AIDS virus appears to be cured. Off medication for almost a year the child, now 2 1/2, is showing no signs of infection.
Noted AIDS researcher Dr. Jeffrey Laurence of Greenwich says of the report, "This is tremendously exciting." Laurence, who is director of the Laboratory for AIDS Virus Research at Weill Cornell Medical College and New York Presbyterian Hospital, and senior scientific consultant at amfAR, was in Atlanta this week where the official report of the cure was presented to more than 4,000 leading researchers and clinicians from around the world at the 20th Conference on Retroviruses and Opportunistic Infections (CROI). Greenwich Citizen caught up with Laurence at the conference by telephone, and learned first hand of the cautious optimism scientists were expressing about the apparent cure.
Q: Is the word 'cure' in this child's case premature?
A: One of the things ignored in much of the media hype was evidence that this was anything like a 'cure' in any sense of that word, or is it simply something we have always known we can do -- prevent an infection with ART (anti-retro viral therapy). The only evidence that anything other than a few T cells were infected in this infant comes from a critical demonstration of the DNA form of the virus in the baby's blood. But, as Dr. (Deborah) Persaud (of John Hopkins Children's Center who deemed the child 'functionally cured') mentioned in her talk, that result was at the very limits of its detection ability. We just need another proof of concept, carefully followed, that newborns can be cured this way. I am optimistic that this is a true cure, and can be replicated.
Q: What was your initial reaction on hearing about the Mississippi child's cure of AIDS?
A: Unlike virtually everyone else at the CROI conference on Monday I had heard all the details about this infant directly from Dr. Persaud when she was applying for funding from amfAR to study this child. I was amazed, because nothing like this had ever been seen in an adult. I also knew, because of the "think tank" I had run on this topic and its potential, that there were probably other babies treated in nearly the same way that were now adolescents, and might also be cured.
Q: You held an AmfAR-sponsored conference last summer on HIV pediatric care. What role do you think that conference played in this most recent development?
A: That conference brought a group of physicians and researchers together to debate the possibility of that happening. It led to the funding of Dr. Persaud several months later to study this new Mississippi case -- which we were unaware of at that time. And Dr. Lynne Mofenson, head of the National Institutes of Health's Children and AIDS Initiative told me just a few days ago that it was the impetus for the federal government to start its own AIDS cure initiative in children.
Q: How does this cure change the way AIDS-infected children will be treated?
A: This finding should lead to a study of the possibility of trying to detect actual infection at the time of birth, plus initiate a 3-drug therapy in those infants. Admittedly, this will expose a number of children who might not need the drugs to treatment before their true status -- infected versus not infected -- is ascertained. But this would be a gift for those who could thus avoid lifelong treatment. The tests and treatment would have much greater implications for the resource-poor world, however, where there are some 330,000 infected kids born annually versus 100 or 200 in the U.S.
Q: Explain the science behind this cure. How was this child treated?
A: Within 30 hours of birth, the child had blood tests for the RNA form of the virus, the so-called viral load, and the DNA form. Both were positive by PCR. Therapy with three drugs, AZT, 3tc, and Nevirapine were then given orally for a week, and then switched to a different, more powerful regimen, for the next 15 or 18 months. Those were AZT, 3tc, and Lopinavir plus Ritonavir, the two protease inhibitors combined in one pill known as Kaletra.
Q: Are there any other children being treated with this protocol?
Q: Could this cure lead to a new treatment for adults?
A: A neonate's immune system is different from an adult's with the possibility that an infant's T cells are much more active than an adult's, so that when infected with a virus, they die quickly before a silent reservoir can be established. It is that reservoir that is the greatest impediment to eradicating HIV from the body, and thus curing AIDS. This has never been seen in an adult but it could have implications for how differently latent HIV reservoirs are established in neonates versus adults. And it may teach us that adults, to be cured by drugs, need to be so treated within a few hours of an established infection.
Q: Are there any implications in searching for a vaccine?
Q: What does this apparent cure point to in further research?
A: The question is: Is it a functional cure, with a minute number of viruses lurking in cells silently infected, below the radar screen of our most advanced detection systems, which could, one day, activate and cause trouble? Was it a true "sterilizing cure," by which all active and dormant viruses were destroyed? And, if the latter, was it accomplished by destroying a nascent reservoir of infected cells, which would have broad implications for how future research to a cure for HIV should be approached, or was potent treatment initiated so early that such a reservoir never had a chance to be established, so that only actively growing viruses were destroyed?
Q: What do you hope happens next?
A: There's an opportunity here for foundations to step up, as there are so many of them involved in saving kids.
On April 6, Dr. Jeffrey Laurence will receive a Visionary Award for his pioneering work on a cure for AIDS by the Red Ribbon Foundation at its SAFE Sex, Drugs & Rock n' Roll biennial gala at the Capitol Theater in Port Chester, N.Y. For more information visit www.redribbonfoundation.org.