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[learn_more caption=”By Dr. Harold Dion”]
Dr. Harold DionHarold Christian Dion studied medicine at the University of Ottawa and Family Medicine at McGill University.

He has worked at the Clinique médicale l’Actuel in Montreal for the past 25 years.
He is also co-editor-in-chief of “e-Relais VIH”, a Canadian bilingual online publication for patients living with HIV.

Over the past 10 years, Dr. Dion has published several articles on various health issues, for both general public (Coup de pouce, 7 Jours, Reader’s Digest) and healthcare professionals (L’actualité médicale, Le Clinicien, l’Omnipraticien, MedActuel FMC, Le Médecin du Québec).

In my very first column in November 2013, I wrote about the “Mississippi baby” (reported at CROI 2013), a baby girl born prematurely at 35 weeks to a mother who learned she was HIV+ at the time of delivery. Given the high-risk situation, the baby was transferred to the Mississippi University Hospital where testing revealed the presence of HIV-1 DNA as well HIV-1 RNA (19,812 copies/mL). Triple combination ART was then started within 30 hours of birth. But after 18 months of treatment, the baby was lost to follow-up and ART treatment was discontinued by her mother. When she returned several months later, her viral load was still undetectable.

In an oral session on Wednesday morning at this year’s CROI, Dr Persaud reported that the baby girl is now 3 1/2 years old and her viral is still undetectable even though she has been off ART for two years. Extensive testing has not found any HIV RNA in peripheral blood cells or reservoirs to date. Traces of HIV DNA have been detected, but not replication-competent virus. Thus, we can conclude that the child remains in remission from HIV (or is “functionally” cured) while off ART.

Dr Persaud also reported on a second baby who was born at Miller Children’s Hospital in Long Beach, California, one month after the “Mississippi baby” was announced. In this case, the mother was known to be HIV(+) from a previous pregnancy, but was not taking her HIV medications. She was given combination ART during labor, and the treatment was also started in the baby, four hours after birth. Tests later confirmed that she had been infected (HIV-1 DNA at 4 hours and HIV-1 RNA (217 copies/mL) at 36 hours of age).

Subsequent analyses at multiple times with the most sensitive tests, suggest that the “California baby”, who is now nine months old, has completely cleared the virus. Since the child was never taken of HIV therapy, we cannot yet talk about a “potential” cure, unless the therapy is stopped and the tests remain negative.

We still don’t know if early triple ARV therapy will cure HIV. These kids will need to be followed very closely for signs of the virus and this treatment strategy needs to be investigated. Studies are now getting under way in the U.S. and other countries, including Canada, where babies receive very aggressive treatment that will be discontinued over time, if tests suggest there is no signs of infection. Preliminary results of the Canadian study will be presented at the CAHR (Canadian Association for HIV Research ) conference that will be held in St John’s, Newfoundland in early May.

D Persaud, A Deveikis, H Gay, et al. Very Early Combination Antiretroviral Therapy in Perinatal HIV Infection : Two Case Studies. 21st Conference on Retroviruses and Opportunistic Infections (CROI 2014). Boston, March 3-6. Abstract 75LB.

I was able to attend this conference with the financial support from Gilead Canada.