Dr. Hannah Gay and her colleagues became the rock stars of the medical community this week after they announced at a conference last Sunday that they'd cured a 2-year-old of HIV by using an aggressive three-drug treatment that started when the little girl was only 30 hours old.
But with excitement comes confusion as experts question whether this so-called cure is real, and whether high doses of potentially toxic drugs should be administered before an HIV diagnosis can be confirmed.
"In trying new things on kids, you want to make sure every 'i' is dotted and every 't' is crossed, because they can't make choices themselves," said New York University bioethicist Arthur Caplan.
Did the Baby Really Have HIV?
The story started more than two years ago in rural Mississippi, where a mother learned she was HIV positive during labor. (Her identity has been kept under wraps for privacy reasons.)
Once the baby was born, doctors wanted to administer the standard dose of antiretroviral medications to prevent the virus from taking hold, but they did not have the liquid version of the drug intended for infants, according to The Associated Press. The baby was transferred to the University of Mississippi Medical Center, where Gay is a pediatric HIV specialist.
The baby girl had a higher risk of being infected with the virus because her mother, not knowing her HIV status, had not taken transmission-reducing drugs during pregnancy, which have been found to reduce the rate of HIV transmission to 1 percent, said Dr. Mark Kline, a pediatric HIV and AIDS specialist at Baylor College of Medicine in Houston. Without these prenatal preventive measures, babies have a 20 to 25 percent chance of becoming infected with their mother's HIV, Kline said.
In other words, babies born to HIV-positive mothers who do not receive prenatal transmission-reducing drugs have, on average, a 75 percent to 80 percent chance of being born free of HIV.
"That's a rather surprising statistic, I think, because you think to yourself: If the mother has HIV, won't the newborn almost certainly also have HIV?" Kline said. "In fact, even in an era in which we did nothing at all, only minor numbers of infants actually acquired HIV infection."
According to the Centers for Disease Control and Prevention, the number of children born with HIV decreased dramatically in the 1990s from nearly 1,700 babies per year to fewer than 150 babies per year. Worldwide, however, 330,000 HIV-positive babies were born in 2011, according to the United Nations.
Gay ran virologic tests just before she started the baby on HIV treatment, but she did not wait the several days it would take for the test results to confirm whether the baby was actually infected.
What Was the Treatment?
Doctors usually give newborns of HIV-positive mothers one antiretroviral -- nevirapine -- for the first six weeks of life, at which point they can confirm the HIV antibodies or HIV DNA and RNA fragments in tests actually belong to the baby, and weren't just passively passed from the mother during birth. By the time the baby is six weeks old, the mother's antibodies and viruses are expected to be gone from the baby's body, eliminating a chance for a false positive HIV test result. (Kline said false negatives were far more likely.)
But Gay decided that this child's risk was too great for standard care.