This week, we learned that a young child from Mississippi who has been known in Infectious Disease research circles as the "Mississippi Baby" now is HIV-positive. She quickly became synonymous with hope for HIV Cure research. This child was born to an HIV-positive mother who did not know her status and therefore did not access antiretroviral drugs during gestation that would have prevented transmission. Unfortunately her daughter was born HIV-positive. The physician caring for mother and baby decided to not follow standard protocol and immediately put the baby on the triple-drug cocktail normally reserved for adults. The baby remained on treatment for 1.5 years before both the mother and baby were lost to care for five months. When the mother did return to the doctor, the baby was tested for HIV and was found to have no trace of the virus. After repeated testing, it was widely accepted that this baby was "cured" of the virus seemingly due to aggressive antiretroviral treatment shortly after infection.
Today, we know now that the Mississippi Baby is no longer virus-free. During her last doctor's visit, detectable viral load was found. This news is devastating for her family and discouraging for the HIV research community. But after decades of research and focused resources to eradicate the world of the virus that causes AIDS and has killed over 36 million people worldwide, there is a glimmer of hope. The Director of the National Institute of Allergies and Infectious Diseases (NIAID), Dr. Anthony Fauci, stated "that early antiretroviral treatment in this HIV-infected infant did not completely eliminate [HIV]... but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period."
Although this update is clearly a setback, it emboldens those of us who have been fighting in this global struggle for decades. HIV care, treatment and research seem to be more often taking two steps forward with each step back. For the first few decades after HIV was isolated and characterized, we far too often took two steps backward with each step forward. The Mississippi Baby has clearly defined the benefit of early and immediate treatment. We can only ensure that that benefit is attained through HIV testing and access to quality sustained care and medication. Earlier this year, researchers detailed that there is no direct evidence that HIV can even be transmitted through sexual intercourse between serodiscordant (one person is HIV-positive and the other is not) if the HIV-positive person has achieved viral suppression through sustained access and adherence to medication. And we also know that persons, who for whatever reason, are not utilizing condoms during intercourse that they can take Pre-Exposure Prophylaxis to avert infection.
These advances combined with behavioral and structural modifications to reduce probability of transmission (condoms, serosorting, sexual positioning, needle exchange) lay the seeds for our ability to End AIDS and subsequently reduce HIV infections. We each had a duty to create an environment where those who are HIV-positive have the resources available to avert HIV progression and clinical AIDS diagnosis. If we accomplish that goal, transmissions will inevitably decrease and we shall beat this pandemic once and for all.
Ace Robinson also formerly worked in HIV Vaccine research with the Fred Hutchinson Cancer Research Center in Seattle, USA.