On March 3, the University of Mississippi Medical Center set off a media frenzy by announcing "the first case of a so-called 'functional cure' in an HIV-infected infant." The child in question, now two and a half, was given antiretroviral drugs less than two days after being born, when doctors discovered that her mother was HIV positive but not being treated, putting the baby at risk of being infected with the virus.  

After a year and a half of antiretroviral therapy, the child's mother halted her daughter's treatment for five months. When doctors examined the child again after this break, they were unable to find functioning virus in her blood.

"A functional cure and fundamental cure are two different concepts," said Tang Heng, Deputy Director of the AIDS Department of the Hubei Provincial Center for Disease Control and Prevention. "A functional cure means that the HIV virus is completely inhibited in the infected person, allowing them to maintain normal immune function. Even if the infected person does not get therapy, the virus can be hardly detected in the blood using conventional methods. But this does not mean that the HIV virus is not present in the body. In this case, inactive genetic traces of the virus can still be detected through hypersensitive testing methods. We can only say that it is unlikely that the child is currently infected. But her doctors will need to conduct further observation and research to fully rule out the possibility." 

According to Tang, a fundamental cure requires the complete eradication of the HIV virus in the human body, which is difficult to achieve at present. "But a functional cure is indeed a breakthrough. If clinical trials verify that this method of treatment is effective for babies, it will bring hope for the elimination of mother-to-child HIV transmission."

"This is the only case, and also a special case because the patient is an infant, meaning her immune system is still growing," said Tang. He believes that the treatment was successful because the early administration of drug therapy prevented the formation of virus repositories in the patient's body. But further research must be done to discover how this happens and to verify that these effects can be replicated in other patients.  

According to Tang, even if the effect is stable, a large number of clinical trials would need to be conducted before early administration of antiretroviral drugs could become a standard therapy approach. Moreover, the child received large doses of antiretroviral drugs soon after she was born, which is not in line with current standard medical practices. In China, infected children are usually given monotherapy for fear of toxicity and side effects. So even if the treatment is effective, patients will still face undeniable risks.

"Rather than administering drug therapy after the birth, it's better to block mother-to-child transmission during pregnancy," Tang said. "The Chinese Government provides free AIDS testing and treatment to pregnant women. Once a woman is found to be infected with AIDS, they can take antiretroviral drugs to reduce viral replication to help prevent mother-to-child infection. The success rate for this treatment plan is up to 98 percent in some developed countries."

Media discussions of this potential breakthrough have also highlighted a serious ethical problem with replicating this treatment plan. In this case, the child's mother, and not her doctors, interrupted treatment. For doctors to knowingly cease to treat an HIV-infected child would put them in violation of ethical standards governing medical professionals. 

At present, only a single individual is known to have been cured of HIV infection. The patient, who was both HIV-positive and being treated for leukemia, was given a stem cell transplant from a donor who carried a genetic resistance to HIV.

Tech Bytes

» The U.S. Food and Drug Administration (FDA) has issued a warning stating that the popular antibiotic azithromycin could put patients at risk of developing potentially fatal irregular heart rhythms. The FDA stated that patients at risk of azithromycin-induced arrhythmia include those who already have a low potassium levels, an abnormally slow heart rate, or those who take drugs to treat arrhythmias. Elderly patients and patients with cardiac disease may also be more susceptible to developing arrhythmias while taking the antibiotic.