Global Implications of HIV Infected Baby Deemed to be Cured

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Marco Werman: I'm Marco Werman. This is The World. If you turn your mind back to the beginning of the AIDS crisis, you'll recall the sense that HIV was a virtual death sentence. Well a lot has changed. Drugs have extended lives dramatically and today we get the remarkable news that scientists have apparently cured an infant of infection with HIV. The girl was born to an HIV positive mother in Mississippi, but we wanted to find out what the news could mean for Africa. Each years thousands of babies there are born infected with the AIDS virus. So we took a trip across town here in Boston to meet with some people who spend a lot of time in southern Africa. So we've come to Boston University where I'm joined by Doctor Julie Herlihy who is assistant professor of international health and pediatrics and by Doctor Donald Thea who is the principle investigator of the Boston University Preventing Mother to child Transmission Project in Zambia and by Leoda Hamomba who is the director for that project in Zambia. Doctor Herlihy, let me ask you first of all: What was your reaction when you heard the news about this child in Mississippi who was apparently cured?

Julie Herlihy: I was shocked. Cure is a word that we haven't used with the HIV/AIDS epidemic for a long time and I haven't the evidence behind and I'd be curious to see the evidence, but as always it's another twist in our journey with HIV/AIDS and I'm very excited to see exactly what happened and what this does mean and the evidence behind it because I think it could have great implications.

Werman: And I have to ask you, Leoda Hamomba, since you've essentially just gotten off the plane from Zambia. You arrive here in the United States, you hear this news, and you're working on this project Preventing Mother to Child Transmission of HIV there. What was your reaction?

Leoda Hamomba: My reaction was, "Well that is great. There's hope. Hope for the future."

Werman: So Doctor Thea, if this research holds up and all the indications are correct about this two and a half year old in Mississippi, what would it mean for a place like Zambia?

Donald Thea: I think it could really, absolutely change the game in terms of preventing mother to child transmission and that's the main focus of what it is that we're doing currently in Zambia. The idea that we could actually prevent infection in these children is revolutionary.

Werman: Do you think this kind of therapy, where there is an aggressive use of several anti-retro-viral drugs, is that feasible in a place like Zambia?

Thea: Absolutely. My understanding is that the regimen of three drugs that are being used, were used, in this child are the same as the regimen that we would put an infected, known infected, child on as well as a regimen that we would put mothers on, that we currently do put mothers in, in Zambia. So if we can arrange to have the testing done at the bedside in some of these clinics and we could put them directly on these medicines, it's absolutely feasible.

Werman: What are your hesitations? What are your reservations about what you've learned so far and whether something like this is reproducible in Africa?

Thea: Well it has funding implications. I think that is also has implications in terms of feasibility. 40 to 60% of women deliver children not in a health facility. They deliver them in their homes and those homes are oftentimes 20 kilometers away from a health facility and it takes many hours for those children to get there. So those sorts of very real world delays may have a very serious implications in terms of the feasibility of this kind of an approach.

Werman: Also as I noted earlier, a lot of children are still being born infected with HIV in Africa. I mean, as exciting as it is to talk about a possible cure, isn't there still a lot of work to be done on prevention?

Thea: Yes, there is. However, we have made tremendous strides in the last three to four to five years in terms of decreasing the mother to child transmission of HIV and I think that this would be a really important addition to the quiver of tools that we have for this situation.

Werman: Doctor Herlihy, we've heard from some people who work on HIV in developing countries that the world seems to be losing interest in HIV and AIDS. That there's kind of a fatigue with the subject and that maybe apathy is setting in. Do you agree and do you think news like this could rejuvenate interest?

Herlihy: I think that's a great question. I think the history of the fight against AIDS has constantly been driven by this idea of a breakthrough that provides some hope and that it gives us something to race towards and I'm hoping that maybe this story is sort of the next benchmark that we can race towards and really galvanize the army that has worked on this for decades to keep charging forward.

Werman: Leoda Hamomba, tell me about the situation in Zambia. I mean, how hopeful are you feeling right now about the way things are being addressed in the realm of mother to child transmission of HIV?

Hamomba: I think we are doing so much better now since we started this fight against mother to child transmission and we have made tremendous strides to where we are now. We manage to test babies at least at six weeks, but we still miss some. Quite a number of babies. So this information, as I said, it gives us hope but there are a lot of logistical problems and funding implications that we need to think about.

Werman: So I don't know how long you'll be here in the U.S., but at some point you'll return to Zambia. I mean, people presumably will want to know, "Well what about this great news about the baby who was cured?" I mean, what will you tell them?

Hamomba: I would tell them that it's good news ahead in the U.S. and I hope it will be investigated further so that we really know what actually happened and then learn from that and then try to do something to save our children.

Werman: But then you need to roll your sleeves up and get back in the trenches on the work that you do everyday.

Hamomba: Yes, of course.

Werman: One thing that seems kind of remarkable, at least on the science of this, is that the doctors in Mississippi kind of came at this baby just hours after it was born with a pretty aggressive cocktail of drugs. First of all, is that correct? I mean, how aggressive is using more than one anti-retro-viral on a child and is this kind of thing where you have lots of inputs and costly medicines, can that be done again in other parts of the world?

Herlihy: It's my understand that the regimen that was used, it was a treatment regimen rather than a prophylaxis regimen and it's a regimen that we commonly use in sub-Saharan African to treat adults and, if we have the pediatric formulations available, then when would also use the same regimen to treat children. So having these meds at hand doesn't seem to be the challenge. Having them on the shelf certainly is always a problem, but I think that timing to treatment seems to be the linchpin that people keep focusing on so far in the media which may have made the difference in this child and that's when you really start asking a health systems infrastructure question. Can we get to kids fast enough and do we know which kids to get to? Do we have the diagnostics available to know which kids would need a regiment as such in order to try to keep the virus from replicating?

Werman: Just in conclusion, I mean, in the world of HIV/AIDS today is a good news day, yes?

Herlihy: It's a great news day.

Thea: Absolutely.

Hamomba: It is.

Werman: That was Leoda Hamomba, director of Boston University's Preventing Mother to Child Transmission Project in Zambia. She joined me at Boston University today along with the project's principle investigator, Doctor Donald Thea, and Doctor Julie Herlihy, assistant professor of international health and pediatrics at Boson University.