"Scientists Report First Cure Of HIV In A Child, Say It's A Game-Changer"This story has been thrown around the internet quite a bit in the last two days. In fact, this story is the perfect example of what I call "The Facebook Effect". I'll write more on this later, but in short it happens when millions of people only read the headline of an article and then share it with millions of other people. The true story gets exaggerated and the science is skewed.
Now don't get me wrong, this is a really cool story. That said, there are some important ethical implications that I'd like to talk about. To understand what I mean I think it's first necessary to talk about the "gold standard" treatment for infants with HIV.
If a pregnant woman is found to be infected with HIV she will be given a cocktail of three potent drugs in an aggressive treatment called HAART (Highly Active Antiretroviral Therapy). This is treatment is to prevent the virus from being transmitted from mom to baby. Upon birth, the baby is given its own 6 week anti-retroviral treatment. This treatment is known to cut the transmission from mother to baby from 25% to 1%. For infants that are HIV positive, the recommended treatment is an aggressive course of anti-retrovirals that continues into childhood.The cure
Ok, so what is so different about this cure? Well, it's really the worst case scenario as far as the gold standard treatment goes. The mother wasn't aware that she was HIV positive, so she didn't receive the pre-natal anti-retroviral treatments. The child was treated with the standard HAART until about 18 months. For some reason, the mother stopped bringing her child in for treatment and the doctors didn't have contact for five months. On a follow-up visit
What does the future hold?
It may seem easy to call this an easy win. We've seen that this treatment cured HIV so now all we have to do is switch to this treatment
There are still plenty of unanswered questions. For example, from the New York Times:
“The one uncertainty is really definitive evidence that the child was indeed infected,” said Dr. Daniel R. Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital in Boston.If the child was actually not infected to begin with this case obviously means nothing. Reports I've seen show that the child was in fact infected, but it's an important question to ask nonetheless.
The thing to remember is that this is just one case. It's an exciting case. It's a promising case. But it's just one case. As of right now we can't actually say that this treatment cures HIV - at least not anymore than we can say that the mother prayed and that's what cured her baby. The next thing to do is create a randomized, controlled clinical trial to test if this treatment regimen.
And now we're back to the ethical dilemma I wanted to bring up. The current gold standard treatment effectively drops the transmission rate from mother to baby to 1%. However, this new "cure" includes no pre-natal care and a limited (albeit still aggressive) treatment after birth. So how will this cure be tested? You can't ethically limit pre-natal treatment, because it would up the transmission rate by 24 percentage points, but you also need to limit that treatment to test this new cure. So how can we ethically recreate this treatment? Remember that part of this "treatment" was a mother who (for one reason or another) didn't bring her infant in for treatment of a known case of HIV.
The experts are currently talking about how this ethical dilemma will be solved and how the gold standard treatment should be modified. I would guess that pre-natal care will change very little as a result of this first case. If an HIV positive woman is pregnant she'll still get the current gold standard treatment, however, I would imagine that an ethical study could be performed looking at mother's who didn't know they were pregnant until delivery. This is really an interesting development, but we'll need to take a much closer look before we call it a cure.
