When a mother known to have advanced AIDS arrived at Miller Children’s Hospital in Long Beach to give birth to her child without receiving prenatal-care treatment, Dr. Audra Deveikis made a tough decision.
The doctor gave the baby an aggressive mixture of three drugs just four hours after birth, deciding to risk any harm that the high dosage of medication may cause in hopes of preventing HIV from being transmitted to the child.
So far, that decision has proved successful.
The child is not considered “cured” or even “in remission” yet since doctors are still prescribing medications, but so far the baby, who is now more than 9 months old, has tested negative for HIV, Deveikis said.
“The baby is doing very well,” said the doctor in an interview with the Signal Tribune at the hospital’s Bickerstaff Pediatric Family Center, which cares for infants, children, adolescents and pregnant women who are at risk for or infected with HIV/AIDS, acute community-acquired illnesses, chronic infections and other immunological diseases.
“The baby is close to a year old and is growing and developing normally,” Deveikis said.
The baby’s recovery was first announced on March 5 during the Conference on Retroviruses and Opportunistic Infections in Boston. It’s the second known case in the United States in which a baby born with HIV has shown no signs of the virus that causes AIDS. A year prior, it was announced at the same annual conference that a baby born with HIV in Mississippi had tested negative after similar treatment that was administered about 30 hours after birth.
Last year’s announcement drew some skepticism though, with claims that the first child, called the “Mississippi baby,” may have never actually been infected. The new case in Long Beach, however, makes the argument stronger that the treatment works, according to leading medical professionals.
Deveikis said results from blood tests and a spinal tap showed a few days after birth that the baby was indeed HIV-positive. But now, DNA tests show the child is negative, she said.
The mother, who according to the New York Times, suffers from mental illness, chose not to take drugs that would have helped prevent HIV transmission to the baby before or during her pregnancy, making the child more susceptible to infection, Deveikis said. Once this was discovered, the doctor decided to immediately put the child on the aggressive three-drug treatment– AZT, 3TC and nevirapine.
“I was on call that weekend,” Deveikis said. “We knew about the Mississippi baby. I watched the video at the previous conference, so I knew that baby was started on three doses of medication rather than prophylaxis medication. Since I knew this was a very high-risk situation, I decided to give the baby treatment doses.”
Deveikis said it was the first time in 18 years that a baby was born HIV positive from a mother who is known to have HIV at Miller Children’s Hospital in Long Beach, noting that most pregnant women who are aware they have the virus go through a prenatal-care process that prevents transmission.
The hospital offers comprehensive evaluation and condition management for infants, children and expectant mothers who are at risk or infected with HIV/AIDS. This comprehensive care includes HIV testing and counseling, clinical drug and vaccine trials, education, psychological care and medical management of the condition.
Deveikis said it’s important for mothers to check their HIV status before and during pregnancy, possibly more than once.
“Some people at high risk actually choose not to get prenatal care,” she said. “Mothers need to come forward to get prenatal care if they don’t know their HIV status and even if they knew they were negative.”
The two cases are now part of a study expected to start soon in which doctors will be looking at HIV-infected infants around the globe in areas that have access to research, such as in South America, Africa, Thailand, India and the U.S., in order to determine the right time for the aggressive treatment.
Deveikis said when the baby in Long Beach was three weeks old, doctors added a fourth medication known as kaletra. A couple months later, the nevirapine medication was discontinued. She said the baby is now expected to continue taking medications for at least the next two years while the studies continue.
“Depending on those studies we might do it longer or not,” she said.
The study is being led by Dr. Yvonne Bryson, who specializes in pediatric infectious diseases at UCLA, and Dr. Deborah Persaud, a virologist at the Johns Hopkins Children’s Center in Baltimore.
The Centers for Disease Control and Prevention (CDC) began recommending routine HIV screening of pregnant women in 1995, following research findings that “HIV medications significantly reduce the risk of transmission from HIV-infected pregnant women to their infants.”
In the last two decades, the number of babies born with HIV in the United States has declined significantly, dropping from “a peak of 1,650 in 1991 to fewer than 200 per year today,” according to the CDC. Reports, however, note that there are nearly 250,000 babies with HIV worldwide.
Deveikis said the “surprise” in the Long Beach case was that the baby’s DNA tested negative for HIV. However, she said “the minute you stop the medications,” the HIV-positive DNA that stays “latent” in blood cells within viral “reservoirs,” often comes out.
In California, a program called California Children Services, covers the cost of drugs for children who have or are at risk of having chronic diseases, Deveikis said. In addition, the Bickerstaff Family Foundation has helped fund health-care services for HIV/AIDS patients since 1985. Still, Deveikis said the case in Long Beach might help the hospital acquire more donations to fund research and treatment in the future.
“We’re hoping that people get inspired that we can do more than we have been doing in the past,” Deveikis said. “For this particular mother, it took the effort of many of us for a couple of days to get her to the hospital, get her treated and everything. It’s not just something you can do for the fee that you get paid by insurance or Medi-Cal. The cost of taking care of this patient is extremely high, and it would be a good idea to have good donors.”
If such a high-risk case arises again, Deveikis said she plans to continue using the aggressive treatment instead of the lower-dose treatment that’s been used in the past.
“I think, in the future, if we have a high-risk patient, rather than giving a little bit of a medication, we’re going to give a lot of medication to try to see if you can prevent it,” she said.