Friday, March 1, 2013

Sequester kicked in and so spending cuts are in effect. Incredible posturing on part of GOP as well as the POTUS who is stating that the “world will come to an end” and the GOP is to blame since they refuse to raise taxes. This is pitiful government. Also, interesting finding being presented at CROI meeting in Atlanta in a couple of days of an infant who was treated (not prophylaxed) with ARVS within 30 hours of birth since his mother who was infected had no anti-natal care and obviously no ARVs. She presented in an ER in Mississippi at labor. The physicians felt that since the risk was so high for the baby that they treated the infant before the tests for HIV came back. They usually take several days to come back. Right choice. The baby was infected and stayed on ARVs for 18 months. Then lost to follow up and mother D/C’d the ARVs for 10 months and reappeared. Only now the baby is well and no evidence of replicating virus (some probably dead residual DNA by PCR. Also, immune response to HIV disappeared (not surprising in the absence of persistent virus). This may be the first real case of a cure, not the “Berlin Patient” whom I always thought was totally non-feasible for scale up and danger. Of note, I have been saying for years that the best bet for a cure was to treat as early as possible to prevent establishment of a large reservoir and to prevent destruction of immune system by persistent viral replication over months to years. The best scenario for this is to treat a child at birth. Perhaps there are other children on therapy who received ARVs relatively early (not necessarily within hours) who are in fact cured and do not know it. Much study to be done.