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Doctors are reporting that a child born with HIV that was put on an unusually aggressive treatment regimen has been functionally cured of the infection. Using the most sensitive HIV testing available, they were able to find only trace amounts of HIV "particles" but no virus capable of replicating, the research team reported.
"If there is a trial that shows this can happen again, then this will be very important," said Dr. Karin Nielsen, a pediatrician who specializes in infectious diseases at UCLA's David Geffen School of Medicine. "You'll be able to treat people very intensively and reverse the disease."
The news provides no answers for adults living with HIV but it can be a landmark victory in the health of future generations. Every year, 300,000 to 400,000 babies are born infected with HIV according to Dr. Anthony Fauci, head of the National Institute for Allergies and Infectious Diseases.
The treatment consisted of giving the newborn a three-drug regimen instead of just one antiretroviral drug. The more extensive treatment was first administered when the girl was just 30 hours old. A month of continued treatment allowed the child’s viral load to become undetectable with standard HIV testing.
The girl received treatments over 15 months and due to unknown circumstances the treatment ceased as the mother stopped bringing her to the doctor. The virus should have returned without ongoing treatment under normal circumstances.
The next step is to attempt to replicate the results in other HIV-positive infants said Dr. Deborah Persaud, a virologist at Johns Hopkins Children's Center. If the triple-drug treatment regimen can replicated it could prove life saving for millions of children.
Preventing mother-to-child transmission of HIV
HIV-positive pregnant mothers should go on a regimen of three antiretroviral drugs (ARVs) as soon as possible — and stay on these drugs until their infant is born and breastfeeding has concluded according to 2010 World Health Organization guidelines.
As soon as the infant is born, the baby should take a very inexpensive drug — daily for six weeks. As HIV can be transmitted through breast milk, the infant should be formula-fed rather than breastfed if possible. However, health officials do recognize that formula feeding is both expensive and difficult to do safely in resource-limited areas. In financial hardships, mothers are recommended to breastfeed exclusively for six months while continuing to take ARVs.
The transmission of HIV from an HIV-positive mother to her child can occur during the pregnancy, labor, delivery or breastfeeding of the child. The transmission rates can be as high as 45 percent according to the World Health Organization. This rate can be significantly reduced to below 5 percent with effective interventions.
UNAIDS advocates four key strategies to achieve this goal. Improving reproductive health and HIV prevention services that will help keep women of reproductive age and their partners HIV-negative. This will help promote safe sex practices and family planning strategies that will avoid unwanted pregnancies among HIV-infected women.
HIV-positive women must be informed of HIV care, treatment and support during pregnancy, delivery and breastfeeding. Globally, there are approximately 1.4 million pregnant women living with HIV and only 26 percent have received HIV testing according to UNICEF. In sub-Saharan Africa only half of pregnant women have been tested for HIV. Of the tested, only 68 percent of HIV-positive women received ARV treatment.
How is HIV transmitted?
A person who has HIV carries the virus in bodily fluids such as blood, semen, vaginal secretions and breast milk. The virus can be transmitted only if HIV-infected fluids enter the bloodstream of another person.
HIV can be transmitted in three ways:
-Exposure to infected blood
-Mother to child transmission
The most common form of transmission is from unprotected sexual intercourse. There are fewer cases of transmission from oral sex but the risk significantly increases if either partner has oral cuts or sores. Sharing one’s toothbrush, canker sores or bleeding gums can increase one’s risk as well.
The use of needles has significantly increased over recent years. Lifestyle factors such as poor diet and lack of physical activity has increased rates of obesity, heart disease and diabetes. It is very common for a diabetic to use needles to inject insulin. This can significantly increase the risk of transmission of HIV.
Tattoos and piercings can also increase the risk of transmission. Studies have shown that HIV can survive in used needles for a month or more.
How is HIV not transmitted?
HIV is not transmitted through food, air or general contact. A person cannot get HIV through re-using washed eating utensils, toilet seats, bathroom sinks, shaking hands or even close contact such as hugging.
Sweat, tears, vomit, feces and urine can contain HIV but are the least likely mechanisms of transmission. Insects and mosquitoes are not able to transmit HIV.
How can I reduce my risk?
If you are sexually active, protect yourself against HIV by practicing safer sex. Whenever you have sex, use a condom. When used properly and consistently, condoms are extremely effective. It’s important to use latex condoms and use them each and every time you have sex. If necessary, consult a nurse, doctor or health educator for guidance on the proper use of latex barriers.
Abstinence is choosing not to have any kind of sexual play with a partner. Being abstinent is 100 percent effective in preventing sexually transmitted infections such as HIV as well as pregnancy. Additional advantages include cost-effectiveness, safe and convenient.
Special Advantages for Teens
Sexual relationships present risks. Abstinence is a very good way to postpone taking those risks until you are better able to handle them. It creates lasting, meaningful relationships that are not centered on sexual behavior.
Women who abstain until their 20s — and who have fewer partners in their lifetimes — may have certain health advantages over women who do not.
Teenagers are less likely to get STDs that could affect their ability to have children or even worse develop a harsh form of cancer called cervical cancer. Cervical cancer rates skyrocket in direct proportion to the number of sexual partners one has.
The healthcare professions and ongoing medical research are allowing people to live longer, have a better quality of life and empower people to take preventative and corrective lifestyle modifications. Taking these steps will significantly reduce one’s risk of contracting and transmitting HIV. The prevention and treatment of HIV has finally given our children and us a glimpse of hope in a previous hopeless condition.
Dr Cory Couillard is an international health columnist that works in collaboration with the World Health Organization's goals of disease prevention and global health care education. Views do not necessarily reflect endorsement.
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