Audacity of hope

The cure of an HIV-infected baby girl in Mississippi could be scaled up to save many more children.

A baby girl born with HIV, the virus that causes Aids, appears to have been cured using a combination of three widely available HIV-fighting drugs. The Mississippi girl, who was declared “functionally cured” by US doctors on Sunday, is now two-and-a-half years old and has been off medication for a year. If she stays healthy, it would be the world’s second reported cure. The only other person cured is Timothy Ray Brown, the “Berlin patient” who became Aids-free after undergoing a stem cell transplant from a donor with a rare genetic mutation that resists HIV infection. What makes the Mississippi baby’s cure more exciting than Brown’s is that she was cured using standard high-dose antiretroviral therapy — ART, the combination of drugs used to treat HIV — within hours of birth.

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In a world where an average drug developed by a pharmaceutical major costs at least $4 billion to as much as $11 billion, a cure using existing and affordable drugs immediately makes it possible for the treatment to be standardised. All pregnant women who deliver at a clinic or hospital are tested for HIV, including in India. Those who test positive are given a drug called Nevirapine that more than halves mother-to-child transmission. A single 200mg-oral dose given to the mother during labour and a single 2 mg/kg dose given to the newborn at 48 to 72 hours after birth halves infection even if the mother and child are not in treatment.

The Mississippi cure is not expected to provide a cure for the 34.2 million people living with HIV. Most people discover they have HIV often years after getting infected. But then the virus that killed more than 25 million people in three decades, is not the killer it used to be. Antiretroviral therapies, now provided free in several countries including India, not only keeps those infected healthy but also makes the infected person less likely to infect others. Globally, 8 million with HIV are being treated with ART. This has led to new HIV infections falling in 33 countries since 2001, mostly in Africa and Asia. Generic drugs have forced the price of one year’s supply of ART to drop from $10,000/person/year in 2000 to less than $100/person/year. In India, where 2.7 million people have HIV, the first-line treatment costs the government just Rs 5,000/person/year. What will make the Mississippi cure more than just a miracle is if it can be scaled up to save other children the world over.