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Child Thought To Be Cured of HIV Relapses, Tests Positive Again

Posted by Soulskill on from the poor-kid dept.

An anonymous reader writes: The Mississippi child, who was born with HIV passed from her mother, received HIV treatment for 18 months after her birth. In the course of over two years after the treatment, her blood indicated no trace of the virus or of HIV-specific antibodies, leading many to hope that she may have been cured completely. Earlier this month, however, the virus was detected again. Nearly 4 years old, the child is once more being given HIV treatment, and scientists are trying to figure out how she could have gone so long before relapsing.

65 of 126 comments (clear)

  1. I hate to imagine it by Anonymous Coward · · Score: 1

    I hate to imagine it....but reinfection?

    1. Re:I hate to imagine it by Major+Blud · · Score: 5, Informative

      When I first read about this on CNN the other day, the article stated that the child's mother had stopped giving her the anti-viral medication she was prescribed. There was no an explanation as to why.

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    2. Re:I hate to imagine it by jellomizer · · Score: 2

      I expect it is more of a case where they got the numbers down so low that the infection wouldn't register, perhaps hibernating in a nook in the body. After the virus stopped getting assaulted it was allow to grow and infect again.
       

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    3. Re:I hate to imagine it by Major+Blud · · Score: 4, Informative

      Found the article:

      http://www.cnn.com/2014/07/10/...

      "The child remained on antiretroviral drugs for approximately 18 months. Her mother then stopped administering the drugs for an unknown reason".

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    4. Re:I hate to imagine it by barlevg · · Score: 5, Informative
      The Washington Post story states:

      Researchers confirmed through DNA sequencing that the infection in the child is not a new infection, but was the one passed from the mother.

    5. Re:I hate to imagine it by Lord+Lemur · · Score: 1

      Well, we know Mom is degenerate in some capacity. My first thought was intentional exposure by Mom.

    6. Re:I hate to imagine it by mwvdlee · · Score: 3, Informative

      GP implies stopping the drugs was the direct cause for the relapse.
      The CNN article states the child was initially "functionally cured" a few months after stopping the drugs.
      The facts us readers know, indicate neither correlation nor causation between stopping drugs and the relapse.

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    7. Re:I hate to imagine it by Sockatume · · Score: 2

      That's what originally excited the doctors: the kid was off her antiretrovirals for two years without relapse.

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    8. Re:I hate to imagine it by i+kan+reed · · Score: 5, Insightful

      Oh this is the most intellectually lazy of bullshit.

      Saying "Why would stopping treatment lead to a relapse?" as if there was no trivially understood relationship there. It's just... silly. I mean, come on bro, no one wants to jump to conclusions, but this is like saying "I stopped watering my houseplant, and at some point, it died. We don't know there's any relationship there."

    9. Re:I hate to imagine it by Wycliffe · · Score: 1

      The Washington Post story states:

      Researchers confirmed through DNA sequencing that the infection in the child is not a new infection, but was the one passed from the mother.

      If the reinfection is also from the mother (which is what is most likely) then how can they tell whether it is the original infection or a reinfection
      from the mother as presumably it's still the same strain in the mother.

    10. Re:I hate to imagine it by wiwa · · Score: 1

      Researchers confirmed through DNA sequencing that the infection in the child is not a new infection, but was the one passed from the mother.

      Well, if it was a reinfection then I would expect the mother (or possibly father) to be the likely source. There are all kinds of ways that a mother could accidentally pass on the virus to a young child, especially if her infection isn't well-managed and the child isn't on anti-retrovirals. Could they tell the difference between the original infection and a reinfection if they came from the same source? I can't see how they could.

    11. Re:I hate to imagine it by gstoddart · · Score: 2

      If the reinfection is also from the mother (which is what is most likely) then how can they tell whether it is the original infection or a reinfection
      from the mother as presumably it's still the same strain in the mother.

      I *think* it tends to mutate when it spreads.

      If it has the virus exact same DNA as the mother (or at least the same strain the child already had), then it likely means that this is the strain the child got while in utero. If it was a fresh infection it would be slightly different from the original infection.

      It sounds like the people who study these things and know what they mean have ruled it out as being a re-infection, but the same infection which has re-emerged.

      I'm going to go with the people who study these things.

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    12. Re:I hate to imagine it by i+kan+reed · · Score: 4, Informative

      Because HIV has numerous properties that allow it to remain dormant in a host for a long time.

      http://en.wikipedia.org/wiki/HIV#Replication_cycle

    13. Re:I hate to imagine it by IMightB · · Score: 5, Informative

      No, if you RTFA, it goes:

      1) Baby has HIV, given retrovirals.
      2) Mother brings in baby for regular checkups/tratments for 18 months
      3) Mother and Baby "dissappear" for a few months
      4) When baby is brought back in, it tests negative for HIV
      5) For about 2 years the baby tests HIV free
      6) Baby tests HIV positive again at ~4.5 years of age.
      7) We suffer from your misinformed post.

    14. Re:I hate to imagine it by Sique · · Score: 1

      By looking at the genetic deviation so far. It can tell you when the both virus tribes have split. If this were a reinfection, it will be genetically even more close to the one found in the mother. If it were an infection from another source, it will be far more different.

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    15. Re:I hate to imagine it by dywolf · · Score: 1

      the problem is thats not exactly what happened.
      this child was not continually observed and studied.
      the mother is apparently not only been bad (and im not passing judgement in saying that) about maintaining the treatment, but also about maintaining any contact or followup with the doctors who did the treatment.

      its like walking in and out of a movie every few minutes for minutes at a time, and trying to figure out what happened while you wre out.

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    16. Re:I hate to imagine it by arth1 · · Score: 1

      If the reinfection is also from the mother (which is what is most likely)

      How can you say that is most likely?
      HIV does not spread easily. The panic times when people wore gloves and masks around the HIV infected are long gone, thankfully. The HIV virus spreading to family members is quite rare.
      Diseases staying dormant for a long time is, however, not unusual at all.
      So again, on what basis do you draw the conclusion that a re-infection is most likely?

    17. Re:I hate to imagine it by gregor-e · · Score: 2

      As wikipedia assures us (emphasis added):

      A retrovirus is a single-stranded RNA virus that stores its nucleic acid in the form of an mRNA genome (including the 5' cap and 3' PolyA tail) and targets a host cell as an obligate parasite. Once inside the host cell cytoplasm the virus uses its own reverse transcriptase enzyme to produce DNA from its RNA genome, the reverse of the usual pattern, thus retro (backwards). This new DNA is then incorporated into the host cell genome by an integrase enzyme, at which point the retroviral DNA is referred to as a provirus. The host cell then treats the viral DNA as part of its own genome, translating and transcribing the viral genes along with the cell's own genes, producing the proteins required to assemble new copies of the virus. It is difficult to detect the virus until it has infected the host. At that point the infection will persist indefinitely.

    18. Re: I hate to imagine it by halo1982 · · Score: 1

      Breast milk for one.

    19. Re: I hate to imagine it by barlevg · · Score: 1

      Post 18 months? Possible, but unless the mother was actively trying to reinfect her kid...

    20. Re:I hate to imagine it by Lord+Lemur · · Score: 3, Insightful

      No, because she abandon treating her child for HIV for 18 Months.

    21. Re:I hate to imagine it by Lord+Lemur · · Score: 1

      Yeah, failing to persue life saving medical care for your child for 18 months indicates that she isn't the best kind person.

    22. Re:I hate to imagine it by DigiShaman · · Score: 2

      Meaning the virus can never be eliminated, but only reduced asymptotically; thus the symptoms are asymptomatic.

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    23. Re:I hate to imagine it by I'm+New+Around+Here · · Score: 1

      I agree with your view.

      I thought one of the properties of viruses is that they often stay dormant for a long time, and then re-emerge.

      Just because she had 'no signs' of infection doesn't mean there weren't a remaining few viruses waiting for the medicine regimen to end.

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    24. Re:I hate to imagine it by fahrbot-bot · · Score: 5, Funny

      ... this is like saying "I stopped watering my houseplant, and at some point, it died. We don't know there's any relationship there."

      My favorite line from a college Logic book: "Breathing causes death. Everyone who has died was an habitual breather."

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    25. Re:I hate to imagine it by i+kan+reed · · Score: 2

      Strictly speaking, the assertion mwvdlee makes is logical. You can't affirm the consequent like that. But it's completely unreasonable in that it freely disregards other available(and in fact trivially commonplace) information about how diseases, and HIV in particular, work.

    26. Re:I hate to imagine it by interkin3tic · · Score: 2

      From this blog post it sounds like the mother taking her off the drugs was what prompted the initial finding: the doctors would have been unethical to tell someone to take their HIV + kid off antivirals because there's a chance they may have killed all the viruses.

      As far as why, the cocktail isn't super convenient. It's a bunch of pills taken throughout the day. Getting a toddler to take multiple pills a day every day is probably a very frustrating thing. I'd imagine the mother (who didn't have any prenatal care and didn't realize she was HIV positive until after birth) doesn't have the best health insurance, so the out of pocket expenses probably really quickly added up.

      I mean, that's obviously all small potatoes compared to developing drug-resistant HIV and full blown AIDS and dying. Not excusing her actions, just saying it's understandable.

    27. Re:I hate to imagine it by Anonymous Coward · · Score: 1

      True, but HIV usually doesn't collectively decide to stay dormant in EVERY cell at once.

      Either some unknown signalling pathway caused the HIV to stay inactive, or it was confined to a reservior that didn't somehow didn't leak for several years. Or she WAS cured, then reinfected.

      The best explaination I can think of:

      The girl was treated before HIV could infect more than a handfull of T-cells. (Or else something unknown killed all but a handful). All of these few stay dormant, until by bad luck the girl encounters an immunogen that activates one of them. Infection proceeds as normal.

    28. Re:I hate to imagine it by Anonymous Coward · · Score: 1

      They take the blood OUT of the patient before they test it that way, moron.

    29. Re:I hate to imagine it by i+kan+reed · · Score: 2

      [calling a moron a moron]

      You're doing god's work.

    30. Re:I hate to imagine it by sexconker · · Score: 1

      Why would stopping treatment lead to a relapse?

      Here's a better question: "why would stopping treatment lead to no relapse for 2.5 years, then suddenly a relapse?"

      Since that asks why what actually happened, happened.

      Why do people get shingles decades after having had chicken pox?

    31. Re: I hate to imagine it by sexconker · · Score: 1

      He made 3 statements.

    32. Re:I hate to imagine it by parkinglot777 · · Score: 1

      The baby continued on antiretroviral treatment until 18 months of age, when the child was lost to follow up and no longer received treatment. Yet, when the child was again seen by medical staff five months later, blood samples revealed undetectable HIV levels (less than 20 copies of HIV per milliliter of blood (copies/mL)) and no HIV-specific antibodies. The child continued to do well in the absence of antiretroviral medicines and was free of detectable HIV for more than two years.

      However, during a routine clinical care visit earlier this month, the child, now nearly 4 years of age, was found to have detectable HIV levels in the blood (16,750 copies/mL).

      Hmm... I would assume that the #5 is correct (see bold portion in the quote from TFA). The only wrong info I am seeing is the "almost 4 years" instead of "4.5 years" time range...

    33. Re:I hate to imagine it by s0nicfreak · · Score: 1

      The mother could have abused the child again

      I'm pretty sure the first time, the child got it from being in the mother's uterus; not from abuse.
      I'm also pretty sure that it would have to be some awfully creative abuse for female to female-4-year-old abuse to spread HIV.

  2. Re:One question by barlevg · · Score: 1

    After 18 months? Unless the mom is Lysa Arryn...

  3. dumb clickbait article by beltsbear · · Score: 2

    Why is this at all surprising? We know how HIV works and that it can hide in cells. So when someone is 'cleared' of it you can never be sure. The longer the drugs are taken increases the chances of clearing any dormant HIV (when it emerges). One can statistically figure out the best time to stop the treatment and many people could be free from reinfection for life but it is not a 100% certainty.

    The only news is that a mother stopped the drugs too early.

    1. Re:dumb clickbait article by Sockatume · · Score: 1

      It's surprising because she wasn't clear of the disease before she went off her medication, and then went two years without a relapse.

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    2. Re:dumb clickbait article by wonkey_monkey · · Score: 1

      Why is this at all surprising?

      Who says it's surprising? "Surprising" is not a necessary property for a story to make the news.

      --
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    3. Re:dumb clickbait article by interkin3tic · · Score: 1

      The initial finding of "baby cured of HIV" was surprising for the reasons you just mentioned. You're suggesting the story shouldn't be updated because it's not surprising? Well, unfortunately, you'll get your wish. I'm pretty sure people will forget this "Nevermind, no miracle after all" and will use the initial story as a reason to go off their meds.

  4. News? by StikyPad · · Score: 2

    The more shocking part of this article isn't that the patient wasn't cured of a disease for which we have no cure, but that anyone thought she was in the first place.

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    1. Re:News? by Tx · · Score: 2

      Umm, they couldn't find any trace of the HIV virus, or specific antibodies to it. It seems reasonable to hope that someone is cured of a disease if you can't find any trace of said disease in their body. And it's not like they jumped the gun on it, she was supposed to be on anti-viral drugs because they weren't sure the virus was gone.

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    2. Re:News? by petermgreen · · Score: 1

      They thought she had been cured because treatement had stopped and the virus had not returned as expected.

      Turns out they were wrong, the virus just took longer to return than expected.

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  5. She didnt relapse, it came back by Gothmolly · · Score: 1

    There's a difference. Given that the human body sucks at fighting HIV, its not as if she did something and 'relapsed', the virus merely came back out of hiding from wherever it lurks (marrow, lymph, spleen, etc).

    It's like how animals don't "evolve", rather then ones who DONT change simply die. No animal DECIDES to suddenly grow fins or stripes.

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    1. Re:She didnt relapse, it came back by MBGMorden · · Score: 1

      It's like how animals don't "evolve", rather then ones who DONT change simply die.

      Untrue - some (many) mutations are bad, and the ones that change are the ones that die.

      Evolution occurs when a mutation is a) beneficial and b) significant enough that it allows an animal to survive longer than those without that mutation. Being alive longer means they breed more. Breeding generally passes on the mutation.

      It really is quite random, and there is no guarantee that the animals that change are better. Indeed for an animal that's particularly well suited to an environment that hasn't changed in a long time there could be very little room for evolution to occur. Certain types of fish (like gar and bowfin) for example have survived for tens of millions of years with relatively minor evolutionary changes.

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    2. Re:She didnt relapse, it came back by gigaherz · · Score: 1

      IIRC, there's proof that the cells can purposefully activate or deactivate certain genes, and those activations become more permanent in the offspring. So animals DO have some level of "purposeful" evolution over their lives, not just over thousands of generations and natural selection.

    3. Re:She didnt relapse, it came back by Khashishi · · Score: 1

      There's a difference? What is the difference? You didn't explain the difference; you just gave some weird analogy.

  6. Re:One question by wiwa · · Score: 1

    Breastfeeding beyond 18 months is pretty common and actually recommended by many health authorities. For example, in Canada the official guidelines recommend exclusive breastfeeding for the first six months, and extended breastfeeding up to at least two years of age.

  7. Re:The answer is simple! by Suiggy · · Score: 1

    This. The mother was jealous her daughter escaped her own fate.

  8. Re:Inserted in her DNA by Sique · · Score: 1

    It is wellknown that every retrovirus does this, and still the most of them can be removed (mostly by the immune system killing off the cells it has infected). But you would still get antibodies pointing to the existance of the virusDNA.

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  9. Re:Get it back from mom by myoparo · · Score: 1

    Yeah except HIV is not communicable via saliva, sorry.

  10. Of course. by gelfling · · Score: 1

    It's not voodoo. It's science. When you stop doing what works, bad things happen again.

  11. Windows by Tablizer · · Score: 1

    That sounds more like Microsoft Windows

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      Yup, if you disable Windows Update and refuse to keep your PC up to date with the latest security fixes, you are going to get malware.

  12. Re:One question by barlevg · · Score: 1

    Yeah, but the mother presumably knows that HIV is passed through breastmilk. So it seems unlikely she would continue to breastfeed longer than absolutely necessary (which, given the existence of formula, means the kid was almost certainly never breastfed).

  13. Re:One question by Lord+Lemur · · Score: 1

    It also seems unlikely that a rational parent would forgo medical treatment for their child for a year and a half. Or would have passed on the chance to prevent initial infection be seeking appropriate treatment during the pregnancy. Or not abandon treatment for another 2 years on a whim. You give her too much credit. She clearly isn't acting in her childs best intrests.

  14. Re:One question by barlevg · · Score: 1

    For 18 months you take your infant to a doctor who pumps her full of drugs, which, while curing her of a terrible disease, gives her horrible side-effects. Then the doctors tell you they think she's cured, but that they want to continue the debilitating drug regimen "just to be sure." Is it really so irrational to say, "No, screw that. My daughter's better now. No need to subject my baby to all this continual agony"? Not saying this is what happened, but since you don't know the specifics and circumstances any better than I do, how about we just forego judgement on this woman?

  15. Re:Sorry, kid by I'm+New+Around+Here · · Score: 1

    Hello!! Spoiler alert!

    Asshole.

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  16. Re:One question by Lord+Lemur · · Score: 1

    But that isn't really what the article outlines. What it does say is that normally upon cesation of retrovirals that the HIV Infection comes back in weeks. It shows that they posted they came to their conclusion that the child might be cured about 16 months ago. When the child would have been 3. After the child re-emerged from the 18 month black out. It never states in there that a Doctor said anything nearly as unfounded or reackless as, "Inspite of this never happening before in the history of human endevor, we are pretty sure your 18 month old is cured." One would expect that they would have been informed that retrovirals are for life, they are not a cure they are a treatment.

    Only after the irrational cessation of treatment, and then the followup testing later was there cause to think, how ever fleeting, that she was cured.

  17. Was she cured? by MouseTheLuckyDog · · Score: 2

    Seems to me stupid to say a person is cured if they have to keep taking meds to prevent a relapse.
    By that standard insulin is a cure for diabetes.

    1. Re:Was she cured? by compro01 · · Score: 2

      Seems to me stupid to say a person is cured if they have to keep taking meds to prevent a relapse.
      By that standard insulin is a cure for diabetes.

      They thought she might have been cured as she went two years without the meds without suffering a relapse. Typically, a relapse occurs within weeks of discontinuing the medication.

      But that ended up bring wrong, as she eventually did relapse, so now they need to figure out why it took so long for that to happen.

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  18. :( What a bummer. by jjn1056 · · Score: 2

    I don't have anything else to add...

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  19. under the gop system pre existing conditions by Anonymous Coward · · Score: 1

    So the relapse will not be covered

  20. Re:One question by Algae_94 · · Score: 1

    Back to the point of a possible breast feeding reinfection. If the doctors believed the child was cured at 3 years of age, there is very little reason for a 3 year old child to be breast feeding.

    Not to mention that DNA analysis indicates it is from the original in utero infection.

  21. Sure It's The Original? by Greyfox · · Score: 1

    It's not like you can't get the HIV again once you've been cured of it. Are we going to rule that out just because we don't want to think about how a 4 year old might contract HIV again after being cured of it?

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    1. Re:Sure It's The Original? by Reziac · · Score: 1

      I had the thought that yeah, since mom is infected it could be a re-infection, but not necessarily through what I suspect you're thinking. Any accidental exchange of bodily fluids can suffice. Did mom have a cold sore and kiss the child on the lips? (Remember kids have potential breaks in the mouth due to new teeth) Might be enough.

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