NIGERIAN scientists are cautiously excited over a medical feat performed by United States (U.S.) doctors through the first ‘functional cure’ of an unnamed two-year-old girl born with the Human Immuno-deficiency Virus (HIV).

Meanwhile, AIDS experts have cautioned against hype of a cure.

While cautiously optimistic, experts stressed that much remained unclear –including whether this may have been a freak result.

The treatment of the girl who now needs no medication after an early treatment with antiretroviral drugs (ARVs), started 30 hours after birth.

The Guardian, however, learnt that Nigerian children might not be able to benefit yet because of late diagnosis and treatment of children born with HIV in the country.

It was learnt that the earliest children are tested for HIV in Nigeria is six months and treatment does not start until after diagnosis; and there is no paediatric ARV for treating HIV positive children less than one year in the country.

The U.S. researchers on Sunday night reported that a baby girl in Mississippi who was born with HIV that causes Acquired Immune Deficiency Syndrome (AIDS) has been cured after a very early treatment with standard drug therapy. They, however, said more testing should be done to see if the treatment would have the same effect with other children.

But the Director-General of the National Agency for the Control of AIDS (NACA), Prof. John Idoko, and the President of the Nigerian Academy of Science (NAS), Prof. Oyewale Tomori, told The Guardian yesterday that the results could change the way high-risk babies are treated and possibly lead to a cure for children with HIV.

Idoko said: “We are all excited about the report. This supports our position that early treatment is key. It is wonderful but we got to be cautious. We need more evidence. It is possible. If it is possible, it is a big lesson. We need more evidence so that we will be able to replicate it in other HIV positive babies and persons.

“So, we should treat early because when we do, we can destroy the reservoir that perpetuates HIV replication. There has been delay about treating children early but with this report, we have to start treatment immediately after diagnosis. But unfortunately the diagnosis is usually made late and some of the paediatric drugs are not used early. Diagnosis is usually late and treatment starts late.”

Tomori said if the report was confirmed, the child born in Mississippi would be only the second well-documented case of a cure in the world.

According to him, the researchers cautioned that the report on the baby girl involves just one patient, and the findings appear to have little immediate relevance to people who contract HIV as adults or adolescents and are almost always diagnosed and treated long after their initial infection.

Tomori further explained: “It is clear that this single case does not alter previous knowledge and information about curing AIDS, especially in adults with well-established AIDS. Remember, this was a case treated early and treated aggressively.

“There is need for caution... how long will the child remain ‘cured’ without treatment? What is the long-term effect of the aggressive treatment on the development of the child? These are questions that only time will answer.”

As to what Nigerian researchers can do to benefit, he said: “The issue is not that of Nigerian researchers alone. We need to improve the research environment at home, through provision of better clinical and laboratory facilities, and our researchers must collaborate with researchers in other parts of the world, where better facilities and conducive research environment exist.”

Meanwhile, scientists at Melbourne’s Alfred Hospital and Monash University yesterday said they hope a world-first treatment for HIV could lead to a cure for the virus. Researchers said they had used a cancer drug to wake up dormant HIV from its genetic hiding place, making it more susceptible to treatment.

Sharon Lewin, the Alfred Hospital’s director of infectious diseases, says 20 patients are taking part in a trial. “The next step is to follow what happens to those viruses once they’ve been woken up,” she said. Lewin said researches hoped the discovery could eventually lead to a cure for the virus.

Also, a study published this week in Science has confirmed the urgent need for rapid and wide-scale roll-out of anti-retroviral therapy to communities which have been most affected by the epidemic.

The study, led by Prof. Frank Tanser from the Africa Centre, spanned a seven-year period (2004-2011), and followed nearly 17,000 people, the largest ever study completed at a population-level in a rural sub-Saharan African setting.

Meanwhile, besides the U.S. report, the only other documented case of an HIV cure to date remains that of Timothy Brown, the so-called “Berlin patient.” In 2006, while on treatment for HIV, Brown was diagnosed with leukemia. His physician was able to treat his leukemia with a stem-cell transplant from a person who was born with a genetic mutation causing immunity to HIV infection. Following the transplant, Brown was able to stop HIV treatment without experiencing a return of his HIV disease.

This new case points to the tantalising possibility that different populations of HIV-positive people might be cured in different ways. While Brown’s case was the outcome of a complex, high-risk, and expensive series of procedures, this new case appears to have been the direct result of a comparatively inexpensive course of anti-retroviral therapy.

The infant described in the U.S. report underwent remission of HIV infection after receiving anti-retroviral therapy (ART) within 30 hours of birth. The investigators say the prompt administration of antiviral treatment likely led to this infant’s cure by halting the formation of hard-to-treat viral reservoirs dormant cells responsible for reigniting the infection in most HIV patients within weeks of stopping therapy.

The researchers said prompt antiviral therapy in newborns that begins within days of exposure might help infants clear the virus and achieve long-term remission without life-long treatment by preventing such viral hide-outs from forming in the first place.

The researchers said they believe this was precisely what happened in the child described in the report. That infant is now deemed “functionally cured,” a condition that occurs when a patient achieves and maintains long-term viral remission without life-long treatment and standard clinical tests fail to detect HIV replication in the blood.

In contrast to a sterilizing cure - a 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, yet discernible by ultrasensitive methods.

The child described in the current report was born to an HIV-infected mother and received combination antiretroviral treatment beginning 30 hours after birth. A series of tests showed progressively diminishing viral presence in the infant’s blood, until it reached undetectable levels 29 days after birth.

The infant remained on ARVs until 18 months of age, at which point the child was lost to follow-up for a while and, the researchers say, stopped treatment. Ten months after discontinuation of treatment, the child underwent repeated standard blood tests, none of which detected HIV presence in the blood. Test for HIV-specific antibodies -the standard clinical indicator of HIV infection -also remained negative throughout.

Currently, high-risk newborns - those born to mothers with poorly controlled infections or whose mothers’ HIV status is discovered around the time of delivery - receive a combination of ARVs at prophylactic doses to prevent infection for six weeks and start therapeutic doses if and once infection is diagnosed. But this particular case, the investigators say, may change the current practice because it highlights the curative potential of very early antiretroviral therapy (ART).

The investigators caution they do not have enough data to recommend change right now to the current practice of treating high-risk infants with prophylactic, rather than therapeutic, doses but the infant’s case provides the rationale to start proof-of-principle studies in all high-risk newborns.

The new model announced by the Global Fund will focus on countries with high disease burden and low resources, allowing the Global Fund to support the countries with the most serious epidemics and least ability to pay.

“The world needs to see this as a proof of concept, but we are not anywhere near implementation” of similar treatment for all newborns at risk, said Harry Moultrie, a paediatric HIV researcher at the University of the Witwatersrand in South Africa, which has a high share of infants born HIV-positive.





“One case does not make an intervention that you can just roll out,” said Moultrie, even as he hailed the result “a compelling description of a cure”.

“They (the researchers) need to keep a close eye on this child to check that the HIV isn’t going to reassert itself further down the line,” said Genevieve Edwards of the Terrence Higgins Trust, a UK-based AIDS charity.

She warned the girl may be one among a handful of people whose immune systems don’t need drugs to keep the virus from replicating.

Moultrie added it remained to be seen whether the treatment would work on all strains of the virus.

“This was one child and we are not sure of the generalisability or reproducibility of the result,” he told Agence France Presse (AFP).

“If we give the same intervention to 100 children we do not know what proportion of them will give the same result; it may be five percent, it may be 80 percent.”

UNAIDS welcomed the development which “gives us great hope that a cure for HIV in children is possible and could bring us one step closer to an AIDS-free generation.” But it cautioned that more study was needed.

“The important thing to concentrate on is to prevent children getting HIV in the first place,” said Oxford University AIDS researcher John Frater.

“It is important not to extrapolate from one single case to others. Plenty of children who would stop therapy would rebound.”

If confirmed, however, the American research would be a massive breakthrough in the fight against a disease that has claimed some 35 million lives.

“Up until two or three years ago, the general scientific belief was that a cure for HIV was impossible: that we shouldn’t research it or invest in it,” said Frater.

“Cases like this tell us that a cure for HIV is not impossible... that this is an area of research that we should concentrate on.”

SOURCE: http://www.ngrguardiannews.com/index.php?option=com_content&view=article&id=115256:first-documented-hiv-cure-case-excites-scientists-&catid=1:national&Itemid=559

HIV Cure at all levels is gonna be a thing of the past..

Cant wait

I was glad to hear it and i hope it will be real and reproducible. It will give hope to many HIV carriers.