HIV Baby 'Cure' Has Ties To Elizabeth Glaser Pediatric AIDS Foundation In Los Angeles

LOS ANGELES -- When doctors announced that a Mississippi toddler born with HIV was functionally cured, the news sent shockwaves around the globe.

But the medical marvel hit close to home for a few residents in Los Angeles -- friends and associates of the late AIDS activist Elizabeth Glaser. Glaser lost her battle with AIDS 19 years ago, but the work she began to eradicate pediatric AIDS worldwide can still be felt through the Elizabeth Glaser Pediatric AIDS Foundation, a nonprofit research organization she founded after her daughter succumbed to AIDS in 1988. In fact, her legacy is imprinted on the so-called Mississippi miracle.

Two doctors involved in the Mississippi toddler's case are recipients of the Elizabeth Glaser Scientist Awards, generous five-year grants of $700,000 that Glaser's foundation gave to leaders in the field of pediatric AIDS research from 1996 to 2006.

Dr. Deborah Persaud of Johns Hopkins Children's Center received the Elizabeth Glaser Scientist Award in 2005. She led the investigation to determine that the toddler's HIV virus was in remission. She conducted the investigation with Dr. Katherine Luzuriaga of the University of Massachusetts Medical School, who was an award recipient in 1997.

The connection to the Mississippi medical case makes Susie Zeegen, one of Elizabeth Glaser Pediatric AIDS Foundation's co-founders, immensely proud.

"We were investing in people, and the people that got this award were above and beyond in their zeal and their promise to be able to come up with new and innovative approaches to the probems that children face," said Zeegen in an interview with The Huffington Post on Tuesday. "I'm sure [Glaser] would be beyond proud and happy as am I."

Zeegen is still awestruck at the apparent "cure." Since news about the toddler broke on Sunday, she has been busy collecting every single article written about the baby. She could only think of one word to describe her reaction: "Wow."

"My overall reaction is of great joy and great optimism," Zeegen said. And in the global fight to eradicate pediatric AIDS, a little bit of optimism couldn't hurt. Currently, an estimated 600,000 babies are born each year with HIV worldwide.

But because of her decades of work with Elizabeth Glaser Pediatric AIDS Foundation, Zeegen is cautious about forecasting what the toddler's cure may mean for pediatric AIDS worldwide.

"What happened in Mississippi is an impetus to get us all charged up again about being able to really and truly eradicate HIV from children," Zeegen said. "There's a ton of work that has to happen, and we all know that."

Chip Lyons, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, echoed Zeegen's enthusiasm and caution.

"The case needs to be very carefully examined," said Lyons. The foundation is focusing on cutting rates of perinatal HIV infection around the globe, especially in India and countries in sub-Saharan Africa. Lyons, based in Washington, couldn't help but give part of the credit for this global movement to Los Angeles, Glaser's home.

"Philanthropists, donors, friends, and particularly the LA community -- there was a remarkable rallying around their friend, who was still fighting for herself, fighting for her son, and fighting to get kids on the agenda," said Lyons.

Glaser founded the organization in 1988 after the death of her 7-year-old daughter, Ariel. When Glaser gave birth to Ariel in 1981, she unknowingly contracted HIV from a blood transfusion and then passed on the disease to Ariel through breastfeeding. Her son, Jake, also subsequently contracted HIV in utero. It wasn't until Ariel started suffering unexplained symptoms that doctors determined all three of them had HIV.

After Ariel died, Glaser was determined to save her son from the same fate. Together with the help of friends Zeegen and Susan Delaurentis, Glaser mined her Hollywood industry contacts (her husband was actor/director Paul Michael Glaser) to raise money and awareness about pediatric AIDS during a time that researchers weren't studying HIV-affected families or pediatric formulations of drug treatments. Now Elizabeth Glaser Pediatric AIDS Foundation has offices in 15 countries and is working on a global scale to bring down the rates of perinatal HIV transmission.

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Stanford pediatric AIDS expert: Was the baby really cured?

In the last few days, there has been much talk about the baby born with HIV who was reportedly cured of the disease – only the second documented case of an AIDS “cure.” Like a good scientist, Yvonne Maldonado, MD, a pediatric AIDS expert at Stanford, is a bit skeptical and says there are many questions yet to be answered.

“It brings a lot of promise and hope but there are lots of details to be looked at before the next step can move forward,” said Maldonado, chief of pediatric infectious disease at Stanford and Lucile Packard Children’s Hospital. She has been doing research on mother-to-child HIV transmission for many years, working with a group of women in Zimbabwe.

According to news reports, the Mississippi mother came to the hospital in labor, and tests showed she was HIV-positive. Because the mother had never been treated for HIV, doctors knew the chance was high that she would transmit the virus to her baby. So within 30 hours of the baby’s birth, they took the unusual step of treating the infant aggressively, with a full cocktail of antiretroviral drugs. The child continued treatment for 18 months, then stopped. And when the mother brought the two-year-old  back for a checkup, tests showed – remarkably – that the baby was virus-free.

One pressing question, Maldonado says, is whether the baby was truly infected. Babies can acquire HIV from their mothers in several ways – either in utero, during labor and delivery or as a result of breastfeeding.

Did this child become infected in utero with the virus, which was ultimately eliminated by the antiretrovirals? Or did the child simply carry some circulating virus from the mother in its blood – and the drugs stopped the virus from establishing itself in the baby?

“Those are two different things,” Maldonado told me. In the first case, “That would be a functional cure. The other would be preventing early post-partum infection,” a form of prevention, rather than cure.

She said there have been anecdotal reports of babies who have been able to clear the virus from their bodies. “You can find virus in infants that then disappears because they haven’t become infected,” she said.

If, on the other hand, this is truly a functional cure, then that has many implications for treatment of infants down the road. “If in fact that was the case, maybe that means instead of giving light therapy to prevent infection, all these babies (of HIV-positive mothers) should be getting heavy-duty therapy right from the start.”

Maldonado notes that pediatrics has routinely led the way in HIV prevention and treatment, as unlike adults, one can often identify when a baby became infected – and then quickly move to intervene. She said it’s unfortunate the latest case, reported at a scientific meeting, occurred during the weekend of the budget sequester.

“Our capacity to study this will be limited,” she said. “NIH will be flat-funded, and yet here’s an opportunity to look at these paradigm-shifting concepts. But these things need resources. It may be a serendipitous finding, but it will be just that if you don’t do more science-based inquiries.”

Previously: International AIDS Conference Day Three: Daring to talk about a cure and Experts discuss German patient who appears cured of HIV

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HIV cure raises hopes tempered with caution

HIV cured in baby for the first time, scientists claim

A baby girl in Mississippi who was born with HIV has been cured after very early treatment with standard HIV drugs, US researchers reported yesterday, in a potentially ground-breaking case that could offer insights on how to  ?

Washington: The report of an American toddler "functionally cured" of HIV has raised hopes of a breakthrough in the global fight to end the AIDS epidemic, but researchers suggest treating the development with caution.

Calling it "The Intriguing Case of a Baby Cured of HIV", The New York Times editorially said: "There are reasons to treat this apparent breakthrough cautiously."

"Researchers must still demonstrate conclusively that the baby had truly been infected and was not simply prevented from absorbing its mother's infection - a process achieved routinely in many babies," it said.

"They must also show that this is not an exceptional, non-replicable case with an atypical baby, but that the same treatment would work in other newborns," the influential US daily said.

Doctors cited by USA today agreed that extending the success in curing the 2-year Mississippi girl infected with HIV at birth "will be a challenge".

Noting that more than 300,000 babies a year worldwide are born infected with HIV, researchers cautioned that "it will likely take years before they're able to extend that success to a broader community of patients, if ever".

Doctors credit the child's cure to early treatment; her physicians began treatment soon after delivery, which is the standard of care for the child of an untreated, HIV-positive mother.

Most adults can't benefit from such early therapy, because they typically don't even learn that they're infected for months or years, USA Today said citing Rana Chakraborty, an associate professor of paediatrics at Emory University School of Medicine.

While the child's story has been hailed as a victory for science, Chakraborty said the case also illustrates the single greatest challenge in treating AIDS: actually getting care to patients.

Delivering on the promise of scientific breakthroughs has been a challenge not just in developing countries of Africa, but in the US, the daily said.

Only 28 percent of people of the 1.2 million HIV-positive Americans have been diagnosed and treated successfully so that their levels of virus are undetectable, according to the Centres for Disease Control and Prevention.

However, CNN said the toddler's case could have wide-ranging effects on the global fight to end the AIDS epidemic.

"If we can replicate this in other infants ... this has huge implications for the burden of infection that's occurring globally," Deborah Persaud, a paediatrician at the Johns Hopkins Children's Centre was quoted as saying.

"For the unfortunate ones who do get infected, if this can be replicated, this would offer real hope of clearing the virus," added Persaud the lead author of a report on the toddler's case.

"We are enthusiastic about the potential of this case, but it is one case and it needs to be replicated and confirmed through future studies and clinical trials," said Meg Doherty, the World Health Organization's Department of HIV/AIDS coordinator of treatment and care, as cited by CNN.

(Arun Kumar can be contacted at arun.kumar@ians.in)

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UMass Medical has role in HIV baby's cure

An infant born with the virus that causes AIDS was “functionally cured” after receiving early, aggressive drug treatment, according to a research team that includes a University of Massachusetts Medical School professor.

The child, a girl born in Mississippi and now 2 1/2 years old, is healthy and in long-term remission, said the researchers, who will present their findings Monday at a medical conference in Atlanta. Traces of the virus known as HIV have been detected in the child using highly sensitive tests, but the virus has not replicated after the child stopped taking medication, said Dr. Katherine F. Luzuriaga, UMass professor and immunologist.

“What we are hypothesizing happened is that by treating this child within days of birth, we were able to minimize the generation of reservoirs,” cells in the body that harbor genetic code for the virus known as HIV, said Dr. Luzuriaga. “And in that scenario, the period of treatment was sufficient to again reduce those reservoirs to the point where, when this child did come off antiretroviral therapy, they were able to maintain control of whatever little virus there may be.”

The researchers discussed their findings today at a news conference in Atlanta. Also on the research team are lead author Dr. Deborah Persaud of Johns Hopkins University School of Medicine in Baltimore and pediatrician Dr. Hannah Gay of the University of Mississippi Medical Center in Jackson. Dr. Gay treated the baby, who was not identified.

HIV can be transmitted through sex, blood transfusions and shared intravenous needles. Infected women can pass the virus to their babies in the womb, during childbirth and through breast milk. When left untreated, HIV destroys an individual's immune system and leads to death.

U.S. public health officials estimate there were 10,834 HIV-infected individuals younger than 13 in the 46 states that report data as of 2009, and 88 percent of those children were infected at birth.

Women can reduce the likelihood of passing HIV to their babies by taking antiretroviral drugs during pregnancy, however, the Mississippi baby was born to a mother who did not know she was infected and had not taken medication to control the virus, the researchers said.
The baby's risk of infection was high, so Dr. Gay started the newborn on the drugs AZT, epivir and nevirapine when she was just 30 hours old, according to Dr. Luzuriaga. Tests later confirmed the infant was infected.

“Since the baby was infected and was already on a treatment regimen, the antiviral medicines were continued with the intent that they would be given for a lifetime,” Dr. Gay wrote in a statement released by the University of Mississippi. “The viral load in the baby's blood fell while on the medicine as was expected and actually fell to below the level of detection of our clinical test within less than a month.”

The child remained on medication and was taken to doctors for regular visits for more than a year. Doctors lost contact with the child for five months, however, catching up with the mother and baby when the child was 23 months old and had been off medication for about five months.

Ordinary tests showed no sign of HIV in the child, but some highly sensitive procedures known as assays detected it, according to Dr. Luzuriaga.

The researchers are preparing a paper on their findings for submission to peer-reviewed research journals. They said they do not have enough information to recommend changes to the way HIV-infected newborns are treated.

“This is one case,” Dr. Luzuriaga said. “It's generated a lot of excitement. It's generated hypotheses for future testing, and I think that's what's going to be important, future testing on this baby and then additional clinical trials to see whether we can replicate this in other children.”

 

 

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Researchers describe 1st 'functional cure' of HIV in baby

Standard tests can no longer detect any traces of the AIDS-causing virus even though the child has discontinued HIV medication.

"We believe this is the first well-documented case of a [functional] cure," said study lead author Dr. Deborah Persaud, associate professor of pediatrics in the division of infectious diseases at Johns Hopkins Children's Center in Baltimore. The finding was presented Sunday at the Conference on Retroviruses and Opportunistic Infections, in Atlanta.

The child was not part of a study but, instead, the beneficiary of an unexpected and partly unplanned sequence of events that -- once confirmed and replicated in a formal study -- might help more children who are born with HIV or who at risk of contracting HIV from their mother eradicate the virus from their body.

Normally, mothers infected with HIV take antiretroviral drugs that can almost eliminate the odds of the virus being transferred to the baby.

If a mother doesn't know her HIV status or hasn't been treated for other reasons, the baby is given "prophylactic" drugs at birth while awaiting the results of tests to determine his or her HIV status. This can take four to six weeks to complete. If the tests are positive, the baby starts HIV drug treatment.

The mother of the baby born in Mississippi didn't know she was HIV-positive until the time of delivery.

But in this case, both the initial and confirmatory tests on the baby were able to be completed within one day, allowing the baby to be started on HIV drug treatment within the first 30 hours of life.

"Most of our kids don't get picked up that early," Persaud explained.

As expected, the baby's "viral load" -- detectable levels of HIV -- decreased progressively until it was no longer detectable at 29 days of age.

Theoretically, this child (doctors aren't disclosing the gender) would have taken the medications for the rest of his or her life, said the researchers, who included doctors from the University of Massachusetts Medical School and the University of Mississippi Medical Center.

Instead, the child stayed on the regimen for only 18 months before dropping out of the medical system and discontinuing the drugs.

Ten months after stopping treatment, however, the child was again seen by doctors who were surprised to find no HIV virus or HIV antibodies with standard tests.

Ultrasensitive tests did detect infinitesimal traces of viral DNA and RNA in the blood. But the virus was not replicating -- a highly unusual occurrence given that drugs were no longer being administered, the researchers said.

No one is absolutely sure why this child achieved a "functional" cure -- meaning the virus is in remission even without medications. But investigators believe that giving antiviral treatment so early in life meant the virus had no time to create viral "reservoirs" where dormant HIV cells can linger for years before becoming active again.

"For us this is a very exciting finding," said Persaud. "By treating a baby very early [we may be able to] prevent viral reservoirs or cells that stay around for a lifetime of an infected person."

But Dr. Michael Horberg, chair of the HIV Medicine Association and director of HIV/AIDS at Kaiser Permanente, stressed that this was a "functional cure and not a cure in the most classic sense of the word."

"If we take adults off HIV medications, they almost certainly within a short time period would have levels of virus back to where they were before they were taking medication," he said.

Only one instance of a "sterilizing cure" -- when there are absolutely no traces of HIV in the body -- has been documented. This occurred in the so-called "Berlin patient," an American man living in Germany who received a bone marrow transplant for leukemia. The transplanted cells came from a donor who had a rare genetic mutation that increases immunity against the most common form of HIV. This patient has remained HIV-free after discontinuing drug therapy.

And Persaud said she is not advocating that the Mississippi case become the standard of care. "This is a single case and we don't really know what are all of the factors [involved]," she said.

But the case does "pave the way now for us to immediately start clinical studies to see if we can replicate these findings in more infants," Persaud said. Those trials are ready to move forward.

At the last follow-up, the child born in Mississippi was "doing well and was healthy," she added.

Horberg said the findings in the baby were "encouraging" but "time will tell" if such a strategy can keep the virus under control for long periods of time without medication.

He emphasized that there are ways to prevent a baby from becoming infected in the first place.

"This again shows the importance of testing pregnant mothers and getting them into care and on [drug] treatment such that we wouldn't even need to worry about it at this point," he said. "What's encouraging, though, if it does come to this point, we might have some good treatment options."

The research presented Sunday was funded by the U.S. National Institutes of Health and the American Foundation for AIDS Research

More information

Learn more about mother-to-child transmission of HIV at aids.gov.

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