Diary Prequel Package — page 346

July 4-8, 2014 - Interesting 4th of July weekend. Found out from Deb Persaud and Hannah Gay that the "Mississippi baby" rebounded at 27 months following D/Cing of ART. Baby is 46 months old. Unfortunately, so much for the "cure" baby. We are sequencing the virus now to determine if this is not a "new" infection, i.e. abuse from an HIV-infected person. More on this later. Also, heard (and spent many hours on conference calls) that an FDA employee who was cleaning out a cold room in Building 29A (FDA building on NIH campus) found a cardboard box that contained 6 glass undisturbed vials labelled "variola". Likely there unnoticed since the 1950s. CDC and FBI notified. Good news is that leaks did not occur and within a couple of days, the CDC came up to NIH, area secured by FBI, and material flown down to CDC on FBI plane. Examined there by Select Agent people and PCR'd to confirm smallpox. Will determine if viable within 1 week and will be destroyed as witnessed by WHO. Technically, the presence of this material in Building 29A was a violation of an international agreement to destroy all smallpox samples except for 2 aliquots kept at CDC and at VICTOR in Russia. July 9, 2014 - PCR confirms that the Mississippi Baby has indeed rebounded with virus at 16,000 and 10,000 copies RNA per ml. Baby has been off cART for 27 months and is 46 months of age. Disappointing, but raises many questions. The baby had no detectable immune response for these many months. Since the virus was obviously there in a reservoir somewhere, what then was the mechanisms that was preventing it from rebounding. Will hold press conference with Deb Persaud, Hannah Gay, and Katherine Luzuriaga on Thursday (tomorrow). Had interesting rounds today to see our first patient (Phil Diers) that received an allogeneic PBMC transfer from a HLA-B27 HIV-infected Elite Controller donor. Recipient has CD4+ T cell count of 0-4 and >150,000 copies of HIV on cART (resistant virus). Hope is that the immune response of donor cells will impact in some way the infected cells of the recipient. More to come. Way out chance of a graft versus infected cell effect that might eliminate reservoir (too much to ask for). See picture below of me on Rounds the day after the allogeneic transfer.