The news continues to make international headlines: A Mississippi baby
born with HIV has apparently been cured of the disease. Aadia Rana, MD,
an infectious disease specialist at The Miriam Hospital, collaborates
with the pediatric HIV specialist who treated the child on research
involving linkage and retention in care among postpartum women in
Mississippi. She offers her insight on this remarkable medical
The child’s mother, who is also HIV-positive, did not receive any
prenatal care, and doctors were only made aware of her disease status
when she arrived at the hospital in labor. Because she was so close to
delivering, she did not even receive a dose of medication that is
routinely given to HIV-infected mothers to help reduce the risk of
transmission to the infant. What happened next?
My colleague at the University of Mississippi Medical Center, Dr. Hannah
Gay, quickly started the baby on full anti-HIV medications within the
first 30 hours of her birth. The infant was found to have the virus in
her blood several times, but after being on therapy for several weeks,
there was no evidence of the virus in her blood as is expected to happen
for someone on treatment. Unfortunately, when the baby was about 18
months old, the mother stopped bringing the infant to her appointments.
They tracked her down five months later and discovered the child’s HIV
blood test showed no evidence of the virus! Dr. Gay involved researchers
at the University of Massachusetts and Johns Hopkins and the tests were
repeated using very sensitive methods, and they did not find any
actively reproducing virus.
When researchers say the child is "cured," what does that mean exactly?
The researchers are terming this case a ‘functional cure.’ This
definition is used when standard tests are negative for the virus, but
it is likely that a tiny amount remains in their body though there is no
evidence it is actively reproducing at this time. This is the case with
this child, even though she has been off of medicine for more than one
Why did this happen?
We are not exactly sure why, but one of the theories is that the child
received therapy with full anti-HIV medications – three medications
instead of one – very quickly after the virus was introduced into her
blood, and the drugs eliminated the virus before it could infect
‘deeper’ cells that function as hideouts for the virus. This is why
adults and older children aren't cured of HIV even when they are taking
anti-HIV medications – there is still evidence of the virus in these
Could this be a game changer when it comes to treating infants born to
I think this case brings up some important questions regarding treatment
of possible HIV infection in the early stages, particularly with regard
to an infant’s immune system. Children infected with HIV are given drugs
with the intent to treat them for life, and anyone who takes the drugs
must remain on them. It is far too early and there are still too many
unanswered questions for anyone to try stopping therapy just to see if
the virus comes back.
The most reliable way to stop babies from contracting the virus from
infected mothers is by identifying and treating HIV-positive women. In
the U.S., these strategies prevent 98 percent of newborn infections. It
is the women who are not identified as HIV-infected or do not receive
therapy who are at highest risk for transmitting the virus to their baby
– like in this case.
What are the next steps in this line of research?
Currently, when an infant is presumed infected with HIV, the plan is to
give the child lifelong medications to keep the virus under control.
With this case, the next step would be to find out if this was an
unusual response to very early HIV therapy, or a finding that can
actually be shown in other high-risk newborns. If that is the case,
there may be opportunities for functional cure in other infants who are
treated with full anti-HIV therapy very early one.
How does this case relate to your area of research?
My research focuses on improving engagement with medical care among
pregnant and postpartum HIV-infected women in the South, which is
significantly impacted by the HIV epidemic. I have been collaborating
with clinicians, including Dr. Hannah Gay and Dr. Binford Nash at the
University of Mississippi Medical Center, to better understand the
barriers to care among these women. I think another key message in this
case is that the child was out of care for five months, at which time
she did not receive any of the medical treatment she may have needed.
Her mother did not receive any prenatal, and given the story, probably
did not obtain medical care after her delivery either. These are very
salient issues that continue to drive the HIV epidemic in this country.