In March, doctors said the young girl was still free of the virus even though she hadn't been on any antiretroviral drugs for about two years. But doctors found detectable levels of HIV, the virus that causes AIDS, in her blood during a routine checkup earlier this month.
So, it just took a little bit longer for the virus to duplicate itself enough to show up on blood tests.
After a second test confirmed the finding, the girl, who is now nearly four years old, was put back on drugs, according to a statement released Thursday by the National Institutes of Health, which is funding analysis of the case and a clinical trial based on its findings. She is being treated at the University of Mississippi Medical Center in Jackson and is doing well, with levels of HIV in her blood now receding as a result of resumed drug treatment, according to the NIH.
The latest development is a blow for HIV/AIDS researchers who had hoped the case would show that very early treatment can rid the body of HIV infection. Normally, AIDS drugs suppress the virus to low levels, but don't get rid of it completely. Rather, HIV hides out in so-called reservoirs in the body that have stumped scientists.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is part of the NIH, called the finding disappointing and said it also raises many questions about how and where HIV lurks in the body. For 27 months, he said, the girl was tested regularly for the virus and none was detected, he said. Then, it just came back.
"It's a very mysterious situation," he said, adding that it shows scientists need to develop better ways to detect the reservoir.
The finding also means researchers will have to re-evaluate a clinical trial that has been planned to test early treatment like the child was given, Dr. Fauci said.
The girl was born prematurely to a mother who had no prenatal care and whose HIV infection was discovered when she delivered her baby. When the baby was 30 hours old, pediatric HIV specialist Hannah Gay started her on treatment-level doses of AIDS drugs, before she was able to find out whether the baby had the virus. The girl, who was infected, stayed on drug treatment under Dr. Gay's care until she was 18 months old, when her mother stopped bringing her in for checkups.
When the mother brought the baby back five months later, the virus was undetectable even though the baby hadn't been on drugs. The girl remained off drugs and regular blood tests showed the virus wasn't detectable until last week.
"It was a punch in the gut to see those test results last week," Dr. Gay said in a statement. "I know intellectually the child is going to be fine, but with a lifetime of medicines ahead, it's more than just a little disappointing."
Only one person is known to have been cured of HIV infection: an adult man known as the Berlin patient, was cured as a result of a 2007 bone-marrow transplant.
In March, doctors said another baby who was born with HIV may have had her infection go into remission after starting drug treatment four hours after birth. But the baby is still on drug treatment, so it is impossible to know whether the virus would return if drug treatment were stopped.
Dr. Fauci said the latest development with the Mississippi girl, while disappointing, won't set back research for a cure. Late last year, President Barack Obama ordered $100 million to be directed toward research on a cure for HIV/AIDS.
"Cure research is still very much in the early discovery phase," Dr. Fauci said. "When you're in the early discovery phase of anything you're going to try things and many are not going to work and some are going to work. I don't think we've gained ground, but we haven't lost ground."
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