AUDIE CORNISH, HOST:
Encouraging news out of a medical conference in Boston this week. Researchers presented early findings in a case of a baby born HIV-positive. After aggressive drug treatment, the baby girl is now testing HIV-negative. Born in Long Beach, California, she was given anti-retroviral drugs, ARVs, four hours after birth and remains on them nine months later.
This is apparently the second such case of a newborn treated successfully for HIV. A baby born in Mississippi three years ago was also given ARVs shortly after birth and so far remains HIV free.
For more, we're joined by Dr. Anthony Fauci. He's director of the National Institute of Allergy and Infectious Diseases, which funded the research in both cases. It's also part of the National Institutes of Health. Welcome to the program, Dr. Fauci.
DR. ANTHONY FAUCI: Thank you. It's good to be here.
CORNISH: So, first, I'd like you to explain the course of treatment. How is it different from the treatment usually given to babies infected with HIV?
FAUCI: Well, in the usual situation, when a baby is born from an infected mother, you don't know at birth for sure if the baby is infected. So what you do is you give the baby what's called preventive type of drugs; lower dose and less in number. When you find out that the baby is ultimately infected, you switch over to the full components of three drugs at the right dose to start treating them.
CORNISH: So it's more drugs at a higher dose.
FAUCI: More drugs at a higher dose. The patients that were reported in the meeting in Boston, the original Mississippi baby and the baby from California, were treated within hours of birth as if they were infected. So instead of giving them the prevention type of a drug over a period of a few weeks, they were immediately given the full-blown course of the treatment drugs. And it turns out, at least in the Mississippi baby, that may have cured the baby because they can't find the virus and maybe even after being off therapy.
The California baby, we still have some proof to do. The baby has been on therapy for nine months but they have not stopped therapy.
CORNISH: Now, at what point will doctors stop the drug treatment? Is it even ethical to do that?
FAUCI: Well, to just empirically stop would not be ethical. And that's the reason why we are sponsoring a clinical trial that will begin sometime at the end of April or the beginning of May, where we are taking a large number of babies of similar situation - babies born of mothers who are infected, who have not received any anti-natal treatment at all - and we are going to be treating those babies literally within 48 hours of birth with the full components of the treatment regiment assuming that they are infected, even though they might not be. And then we'll wait for a considerable period of time and very carefully in individual babies stop therapy to see if the virus rebounds.
CORNISH: And we should say this is all very different than the case of the baby born in Mississippi in which the mother stopped treatment.
FAUCI: Right. The doctors would never have just empirically stopped drug in the baby after several months. The mother was lost to follow-up and stopped giving the drug to the baby. And then when they came back, the physicians noticed that it had been several months off therapy and the virus did not rebound. So a quirk of a mother's decision or accident in not following up with the baby has actually led to a situation that turned out to be beneficial.
CORNISH: We've reported on this program that there are already extremely effective drug regimens for preventing the birth of HIV-positive babies. But give us some context here. Just how big a problem is it babies born HIV-positive?
FAUCI: In the United States, it's really not a big problem at all only because we have the anti-natal care for the mothers and all those all mothers who are infected will be started on therapy. When the mother is on therapy then it is extremely unlikely that the baby will be infected, not the impossible, but very, very unlikely.
However the situation in the developing world is somewhat different where it's really not uncommon that a mother will come into a clinic in labor, ready to deliver, never having seen a health care provider and not being on antiviral therapy. Those are the babies that are the highest risk. So it really depends on where in the world you are whether this kind of immediate treatment would be applicable.
CORNISH: Dr. Anthony Fauci, he's director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
Thank you so much for speaking with us.
FAUCI: Thank you. Good to be with you.
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