What Have We Learned About HIV from the “Mississippi Baby?”

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There's good news and there's real sobering news about the Mississippi baby. The good news, is that the very early, within 30 hours of birth that the Mississippi baby was treated, resulted in a very prolonged remission off antiviral therapy, 27 months. That's a very long time, following discontinuation of therapy.

The sobering news, is that during that period of time, when the physicians and researchers examined for the presence of a reservoir of virus, there was no replication competent virus that was detected. So there was an assumption on the part of some, certainly not me because I've become so cautious over the years, that, in fact, this was eradicating, the body had rid itself of HIV, and then 27 months after the discontinuation of therapy, the virus rebounded very robustly which tells us some sobering things that A) this reservoir is a very wily recalcitrant phenomenon, because we don't have the tools sensitive enough to detect it. We thought it was gone, but it wasn't, and we're absolutely certain it wasn't gone because it came back even though it was not detectable for 27 months.

There was enough virus in there that by some phenomenon that we can't explain after 27 months re-emerged. So that tells us that eradication of the virus in someone, particularly who's been infected for a long time, is going to be a formidable, if not insurmountable obstacle towards the cure. So it may be that we may not, I'm not saying we're giving up, but we may not be able to eradicate the virus from someone that's been infected for one or two or three years, we couldn't even do it in a baby that was treated within 30 hours of birth.

You can imagine how hard it will be to do a real eradication, so there may need to be other ways of approaching, getting somebody who's doing very well on therapy, how do you get them off a life-long course or a life-long commitment to antiretroviral therapy. You could do it by enhancing the immune system, by therapeutic vaccine, we're trying all of these.

Which one will be, if any of them, successful, we don't know.