Diary Prequel Package — page 306

Mar. 1, 2013 - Sequester kicked in and so spending cuts are in effect. Incredible posturing on part of GOP as well as the POTUS who is stating that the "world will come to an end" and the GOP is to blame since they refuse to raise taxes. This is pitiful government. Also, interesting finding being presented at CROI meeting in Atlanta in a couple of days of an infant who was treated (not prophylaxed) with ARVS within 30 hours of birth since his mother who was infected had no anti-natal care and obviously no ARVs. She presented in an ER in Mississippi at labor. The physicians felt that since the risk was so high for the baby that they treated the infant before the tests for HIV came back. They usually take several days to come back. Right choice. The baby was infected and stayed on ARVs for 18 months. Then lost to follow up and mother D/C'd the ARVs for 10 months and reappeared. Only now the baby is well and no evidence of replicating virus (some probably dead residual DNA by PCR. Also, immune response to HIV disappeared (not surprising in the absence of persistent virus). This may be the first real case of a cure, not the "Berlin Patient" whom I always thought was totally non-feasible for scale up and danger. Of note, I have been saying for years that the best bet for a cure was to treat as early as possible to prevent establishment of a large reservoir and to prevent destruction of immune system by persistent viral replication over months to years. The best scenario for this is to treat a child at birth. Perhaps there are other children on therapy who received ARVs relatively early (not necessarily within hours) who are in fact cured and do not know it. Much study to be done. Mar. 4, 2013 - The media interest in the "cured" baby has been as intense or more than anything I have experienced here at NIH. Yesterday I did WUSA 9 nightly news and today I did: CBS Morning News with Charlie Rose and Nora O'Donnell; WTOP Radio; Fax Morning News; CBS Radio LA; Fox Radio News; NBC News and NBC Nightly News; ABC Evening News; BBC World Service Radio; Canadian Broadcast (CBC) TV; CNN International with Christianne Amanpour; CNN Situation Room with Wolf Blitzer; WLS radio; PBS NewsHour with Ray Suarez; BBC Radio; Canada CNN Radio; CNN Anderson Cooper 360; Al Jazeera. Quite a day. I stressed that we must be careful since this is only a single case in very unusual circumstances. All media went very well. Mar. 5, 2013 - Media frenzy continues. I have now gone over the data from the Hannah Gay and Persaud presentation at CROI and I have some doubts that the child was ever truly infected in the first place. Tough to really tell whether the virus that was detected and ultimately disappeared on ARVs was the virus from the mother or really infected baby cells making virus. The authors claim that the 2 phase decay of virus on ARVs is characteristic of the response to active virus replication. Cliff Lane pointed out that the decay curve has very few points and is also compatible with a single phase decay. In any event, I have been taking the conservative approach of emphasizing that this is just a single case and it needs to be replicated and validated and importantly, it has little to do with infection in the adult where reservoirs are firmly established prior to the start of ARVs. Nonetheless, the media frenzy continues with interview for Men's health, Huffington Post, NPR- San Francisco (KQED), Boston Globe.