Thursday, 19 September 2013

Breakthrough might lead to changes in HIV treatment guidelines

An announcement in Mississippi of the curing of an HIV born infant has generated excitement about the possibilities of HIV cure in infants.

If proven true after a long term follow up, the development has the possibility of pushing for a change in the guidelines regarding the timing of HIV treatment in infants, in the longer future.

Currently under WHO guidelines, it is only 6 weeks after birth that detection tests are done. In this case, the treatment happened 30 hours after birth. Moreover, treatment was more intense than usual where doctors at the University Mississippi medical centre used three antiretroviral drugs instead of the usual singe dosage, agencies reported.

Though the presence of the virus had not been detected in the mother, the treatment was done before the virus could set into the body completely.

Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center, was quoted by CNN as saying, “ We are hoping that future studies will show that very early institution of effective therapy will result in this same outcome consistently,".

However, doctors and experts in India who DNA contacted, refused to comment till they have more details and till long termfollow up is done. They also hinted at the possibility of this being an 'exceptional case.'.

A National Aids Control Organisation (NACO) official told DNA that “ There are some researchers in South Africa who have also been talking about taking treatment in the direction of early treatment, unlike the current 6 weeks directive.

 But on the basis of one case like this, one cannot expect a change in guidelines which have been formulated after years of research and sample cases. Neither is it advisable to push for it on the basis of just one case.”

The official added that “cure” is too early a word to use. “ A case certainly is being made for early detection leading to a reduction in mortality. I would not use the word cure. Currently, 25% of HIV infected infants die within year and 50 % in 2 years” the official said.

India has the third largest number of people living with HIV according to government's 2011-12 data. However, according to the Department of AIDS Control's Annual Report 2011-12 , only 5% of HIV cases in India are transmitted from mother to child.

Yet, the news remains relevant to India as to other parts of the world because pregnant HIV infected women are a vulnerable group because of lack of infrastructure, testing facilities, knowledge and income levels. Detection facilities too have lagged behind.

This means that most women would not even know they are infected with the virus till it is too late and the baby already born. This is why the Missisippi case, if proven to be applicable universally, makes sense for India since the infant had been born with the virus in an undetected mother.

Anjali Gopalan director of Naaz Foundation which works with individuals affected by HIV says, “It's too early to say whether the cure will be applicable to India, but if it is then it is definitely exciting news. It gives hope to newly born infants infected with the virus”.

The infant from Mississippi was born HIV-positive to a mother who had not been diagnosed as HIV-positive herself until just before delivery. After initial treatment, the mother and child remained absent from the hospital for 5 months. They returned to the hospital when the child was 2 years old, and doctors found remarkably, that she tested negative after repeated tests.

ICMR Secretray Dr V M Katoch refused to comment till further details are forthcoming. Most doctors too reserved their opinion till they got further details. The NACO official also insisted that “long term follow up is necessary before a comment can be made”.    

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