By Gerald V. Paul
Dr Deborah Persaud, a Guyana-born doctor, hailed as one of the best and brightest AIDS researchers in the field today, is at the centre of world media attention as she contributed towards the cure of a U.S. baby with AIDS with very early treatment.
This is the first account of an infant achieving a functional cure, but more testing will have to be done to see if the treatment will work on other children.
Doctors warn parents not to be tempted to take their children off treatment to see if the virus comes back. Normally when patients stop taking their medications, the virus comes roaring back, and treatment interruptions increase the risk that the virus will develop drug resistance.
Dr Persaud, who lived in Guyana until she was 16, moved to greener pastures in Brooklyn, N.Y. in the at-risk neighbourhood of Bushwick. After Persaud completed High School and college, just one medical school, NYU, accepted her. That was all she needed to get on a career trajectory that would consistently put her precisely in the right place at the right time.
At NYU in 1985 was when the first HIV cases were being identified in young, gay men. During her residency at Columbia Presbyterian, she started seeing infants being presented with the same type of pneumonia.
“It was actually devastating because an infected infant meant an infected mother, father and, possibly, other siblings. Eighty percent of these infants died in the first year of life, and we could do nothing. We had no therapies,” Dr. Persaud said.
Today, HIV infection has been transformed into a preventable, treatable disease in children and Dr. Persaud now is studying the virus at the single-cell level.
“I have been fortunate to have witnessed the beginning of the epidemic and the multiple phases of HIV infection. It’s been transformed into a chronic infection. What I hope for the future is to be able to see a similar transformation in resource-poor settings,” Dr. Persaud said.
Meanwhile, according to her colleague, Dr. Ben Gay, “Patients who are on successful need to stay on their successful therapy until we figure out a whole lot more about what was going on with this child and what we can do for others in the future.”
The researchers are trying to find biomarkers that would offer a rationale to consider stopping therapy within the contex of a clinical trial. If they can learn what caused the child to clear her virus, they hope to replicate that in other babies, and eventually learn to routinely cure infections.
The infant was put on a cocktail AZT, lamivudine and nevirapine for 48 hours.
“We started therapy as early as possible,” said Dr Persaud.
Dr. Persaud , the winner of the prestigious Glaser Award, noted the researchers have little doubt that the child, who is now two-and-a-half years old, experienced a “functional cure.”
The doctors said the child has been off the drugs for a year and shows no signs of functional virus.