A flurry of excitement over a claimed "functional cure" for HIV opened the 20th Conference on Retroviruses and Opportunistic Infections (CROI) here in Atlanta. But questions remain about some of the details of what happened with the young girl, and even if it proves to be true, it is likely to have little immediate or widespread effect in daily care.
The case study involved a girl born prematurely at the University of Mississippi to a mother who was infected with HIV but did not know it. Because the mother had a high viral load at the time of delivery, and likelihood of transmission of the virus increases as viral load increases, the physician decided to test the infant for HIV and started her within 30 hours of birth on combination therapy.
The viral load test came back showing 20,000 copies of HIV. That strongly suggests she became infected in the womb and not at delivery, which is another point of high risk for mother to child transmission. While the RNA test for the virus showed that it was replication competent, there was no reason at the time to run a test used only in research and not in clinical practice to show if the virus was capable of infecting cells. A significant portion of HIV RNA has defects that leaves it incapable of infecting cells.
The infant remained on antiretroviral drugs for 18 months and then mother and daughter stopped going to clinic. They reappeared four months later and the girl had not been on therapy for much of that time. The doctors took a blood sample to measure her viral load but it was below the 20 copy level that they used.
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