Deborah Persaud, a Johns Hopkins virologist specializing in pediatric infectious disease, was just named one of "Nature's 10" for discovering what's being called the first "functional cure" of an HIV-infected infant. Along with doctors Hannah Gay of the University of Mississippi Medical Center and Katherine Luzuriaga of the University of Massachusetts Medical School, Persaud was able to help the infant achieve, as she says, "long-term remission without lifelong treatment."
Gay, a pediatrician, originally contacted Persaud in September 2012 regarding one of her patients—a baby born with HIV. From Nature:
Because the mother had gone untreated for the duration of her pregnancy, Gay gave the baby high doses of three antiretroviral drugs—zidovudine, lamivudine and nevirapine—within hours of birth. Tests conducted at the time showed that the baby had HIV, and the mother was told to continue the child on treatment. At one check-up, however, Gay found that the baby had not been getting her drugs for five months. Gay tested the child and found no sign of the virus.
To make sure that this was not another false signal, Gay called in Persaud and Luzuriaga. They matched the mother's DNA with the baby's to be sure that she had not been switched in the hospital. They took five separate blood samples for the HIV tests and personally checked each lab result. As they ruled out alternative explanations, it looked more and more likely that the initial blast of drugs had wiped out the virus. They published a paper describing the case in November, and so far it seems to be standing up to scrutiny.
Complete eradication of HIV is the ultimate goal, but for now, says Luzuriaga, that "remains out of reach." As she sees it, "our best chance [to eradicate HIV] may come from aggressive, timely and precisely targeted use of antiviral therapies in high-risk newborns as a way to achieve functional cure."
In contrast to a sterilizing cure, which would be a complete eradication of all viral traces from the body, the functional cure Persaud and her collaborators discovered occurs when viral presence is so minimal that it remains undetectable by standard clinical tests, yet discernible by ultrasensitive methods.
A clinical trial is currently being planned by the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) to test Persaud's "functional cure" in high-risk infants. (Persaud is an adviser for IMPAACT.)
Of course, as Gay notes, prevention is really the best "cure." In fact, she says, doctors "already have proven strategies that can prevent 98 percent of newborn infections by identifying and treating HIV-positive pregnant women."
Persaud knows her task is a difficult one. But, as she tells Nature, her discovery "could be the tipping point in HIV therapy for children."Read more from Nature