Emily Le Coz

The Clarion-Ledger

The Mississippi child hailed last year as the world's first person functionally cured of HIV saw the immunodeficiency virus return this month, shattering researchers' hopes for a long-term cure and likely condemning the girl to a lifetime of medication.

National Institute of Health officials announced the findings Thursday.

"The baby does have HIV again," said Anthony Fauci of the NIH during a conference call with the media.

Fauci said doctors will continue following the girl, who currently is 46 months old, in an effort to understand why the virus returned and whether she still holds the key to a functional cure.

"It felt very much like a punch to the gut," said Dr. Hannah Gay, the University of Mississippi Medical Center pediatrician who had been credited for the remission. "It was very disappointing."

The girl was born in 2010 to an HIV-positive mother who had passed along the virus in utero to her infant.

It's rare today for babies to be born with HIV, because doctors now routinely treat HIV-positive pregnant women with anti-retroviral medications and give preventive treatment to babies for the first six weeks of life.

But because this mother had no prenatal treatments, the infant was born with the virus. Gay gave her an aggressive anti-retroviral therapy within 30 hours of her birth, and the virus eventually went into remission. It was completely undetectable one month later.

Normally, doctors would keep an HIV-positive baby like this on medications for the rest of her life for fear the virus would come raging back. But the girl and her mother disappeared when the child was 18 months old.

After they missed several appointments, doctors asked social services to track them down. When mother and child finally returned to the hospital five months later, the mother admitted she had not given the girl her medication.

"I expected the baby's viral load to have gone back up," Gay said. "But when we drew the test, we got back still an undetectable viral load. That was a surprise to me."

It had appeared the early, aggressive treatments halted the formation of hard-to-treat viral reservoirs — dormant cells responsible for reigniting the infection in most HIV patients within weeks of stopping therapy. Tests of HIV-specific antibodies also remained negative.

The discovery led to a story in the New England Journal of Medicine and the announcement of the world's first functional HIV cure. In contrast to a sterilizing cure — complete eradication of all viral traces from the body — a functional cure occurs when viral presence is so minimal it remains undetectable by standard clinical tests.

Since then, at least one other baby also has been reported cured of the virus using the same early, aggressive treatment. That child, who lives in California, remains HIV-free.

Despite the disappointing return of the virus in the Mississippi girl, Fauci said the fact she remained HIV-free for 27 months without treatment is significant and will be the subject of further study.

"We do not know what the triggering event was," said Gay, explaining that she tested the girl's blood every six to eight weeks and that it had been normal every time until last week.

As soon as she realized the virus returned, Gay said, she started the girl on immediate treatment. Three days later, her blood counts normalized. The girl likely will continue medications for the rest of her life, as do most HIV-infected individuals.

"Obviously this is very disappointing news for this child who will now need drugs," said Deborah Persaud, a virologist at Johns Hopkins University School of Medicine and part of the girl's medical team.

Yet Persaud said the girl's unprecedented, albeit temporary, remission supports the idea that early treatment could one day lead to a more permanent solution.

Persaud also noted that the girl was not reinfected with HIV. The virus present in her body post-remission is the same one she had received in utero, according to tests.

Gay would not share details about her patient or the family's reaction to the news, but she said the child can expect to lead a "long and healthy life."

"And while, as a clinician, I am more than disappointed for the child," because of the lifetime of medication she faces, Gay said, "I am hopeful for all researchers still looking for a cure."

To contact Emily Le Coz, call (601) 961-7249 or email elecoz@jackson.gannett.com. Follow @emily_lecoz on Twitter.