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An HIV case first documented in a Mississippi baby 18 months ago is still proving that an antiviral treatment early on is effective in not only treating the virus that causes AIDS, but also curing it.

Earlier this year, researchers from Johns Hopkins University (JHU) reported that a child born with HIV and treated with a series of antiviral drugs showed signs of remission within days of initial treatment. The child was administered antiretroviral therapy (ART) for the next 18 months before ultimately being taken off the drugs.

The researchers, led by Deborah Persaud, MD, of JHU, conducted a follow-up in late 2012 when the child was 23 months of age and found that, after conducting a battery of tests, the infant was in full remission with no visible signs of HIV in the body. They presented their findings at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta, Georgia.

REMISSION CONTINUES

Now, more than 6 months later, the same researchers have conducted another follow-up and are happy to report that the child, now 3 years old, is still free of active infection 18 months after all treatment ceased. A new report on the case has been published in the Oct. 23 issue of the New England Journal of Medicine (NEJM).

Our findings suggest that this childs remission is not a mere fluke but the likely result of aggressive and very early therapy that may have prevented the virus from taking a hold in the childs immune cells, says Dr. Persaud, a virologist and pediatric HIV expert at Johns Hopkins Childrens Center (JHCC), who has been handling the case since the child was born.

Persaud has worked on this case with immunologist Katherine Luzuriaga, MD, of the University of Massachusetts Medical School, and pediatrician Hannah Gay, MD, of the University of Mississippi Medical Center, who identified and treated the baby and continues to see the child.

Were thrilled that the child remains off medication and has no detectable virus replicating, Gay says. Weve continued to follow the child, obviously, and she continues to do very well. There is no sign of the return of HIV, and we will continue to follow her for the long term.

The child was born to an HIV-infected mother and was administered ART within 30 hours of birth. A series of tests in the subsequent days and weeks showed the ART was continuing to diminish the overall presence of the virus in the childs blood, until it reached undetectable levels 29 days after birth. At 18 months of age, the child was lost to follow-up for nearly five months, and ART stopped; but when checked after another five months, testing could still not detect virus in the bloodstream.

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First Ever Baby Cured Of HIV Still In Remission 18 Months Later

Oct. 23, 2013 A 3-year-old Mississippi child born with HIV and treated with a combination of antiviral drugs unusually early continues to do well and remains free of active infection 18 months after all treatment ceased, according to an updated case report published Oct. 23 in the New England Journal of Medicine.

Early findings of the case were presented in March 2013 during a scientific meeting in Atlanta, but the newly published report adds detail and confirms what researchers say is the first documented case of HIV remission in a child.

"Our findings suggest that this child's remission is not a mere fluke but the likely result of aggressive and very early therapy that may have prevented the virus from taking a hold in the child's immune cells," says Deborah Persaud, M.D., lead author of the NEJM report and a virologist and pediatric HIV expert at the Johns Hopkins Children's Center.

Persaud teamed up with immunologist Katherine Luzuriaga, M.D., of the University of Massachusetts Medical School, and pediatrician Hannah Gay, M.D., of the University of Mississippi Medical Center, who identified and treated the baby and continues to see the child.

"We're thrilled that the child remains off medication and has no detectable virus replicating," Gay says. "We've continued to follow the child, obviously, and she continues to do very well. There is no sign of the return of HIV, and we will continue to follow her for the long term."

The child was born to an HIV-infected mother and began combination anti-retroviral treatment 30 hours after birth. A series of tests in the subsequent days and weeks showed progressively diminishing viral presence in the infant's blood, until it reached undetectable levels 29 days after birth. The infant remained on antivirals until 18 months of age, at which point the child was lost to follow-up for a while and, physicians say, stopped treatment. Upon return to care, about 10 months after treatment stopped, the child underwent repeated standard HIV tests, none of which detected virus in the blood, according to the report.

The child's experience, the authors of the report say, provides compelling evidence that HIV-infected infants can achieve viral remission if anti-retroviral therapy begins within hours or days of infection. As a result, a federally funded study set to begin in early 2014 will test the early-treatment method used in the Mississippi case to determine whether the approach could be used in all HIV-infected newborns.

The investigators say the prompt administration of antiviral treatment likely led to the Mississippi child's remission because it halted the formation of hard-to-treat viral reservoirs -- dormant HIV hiding in immune cells that reignites the infection in most patients within mere weeks of stopping drug therapy.

"Prompt antiviral therapy in newborns that begins within hours or days of exposure may help infants clear the virus and achieve long-term remission without the need for lifelong treatment by preventing such viral hideouts from forming in the first place," Persaud says.

Remission, defined in this case not only by absence of infection symptoms but also by lack of replicating virus, may be a stepping stone toward a sterilizing HIV cure -- complete and long-term eradication of all replicating virus from the body. A single case of sterilizing cure has been reported so far, the investigators note. It occurred in an HIV-positive man treated with a bone marrow transplant for leukemia. The bone marrow cells came from a donor with a rare genetic mutation of the white blood cells that renders some people resistant to HIV, a benefit that transferred to the recipient. Such a complex treatment approach, however, HIV experts agree, is neither feasible nor practical for the 33 million people worldwide infected with HIV.

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Child born with HIV still in remission after 18 months off treatment

23.10.2013 - (idw) Jacobs University Bremen

MHC tetramers are important diagnostic reagents that are used by doctors and scientists to follow a patient's immune response against a virus or a tumor. Their application has so far been limited because they are difficult to make and expensive. An invention by the research group of Sebastian Springer, Professor of Biochemistry and Cell Biology at Jacobs University, now promises to change that. MHC class I molecules are proteins that bind to peptides from the interior of infected or cancerous cells and transport them to the cell surface. There the virus- or tumor-derived peptides are recognized by cytotoxic T lymphocytes, so-called killer T cells, with the help of their T cell receptors. The killer T cells can then remove infected or malignant cells by inducing programmed cell death. To find out how many killer T cells exist for each virus or tumor peptide, doctors and scientists use the same MHC class I proteins, bound to that peptide and tied together in clusters of four, to stain T cells from patient blood. These clusters of four, or 'tetramers', are made in a multi-step process that takes several weeks and is expensive. For every new peptide scientists want to investigate, the production process has to start over, which adds to the cost.

For questions regarding the study, please contact: Sebastian Springer | Professor for Biochemistry and Cell Biology E-Mail: s.springer@jacobs-university.de | Tel.: 0421 200-3243

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Immune system monitoring improved

Posted: Monday, October 21, 2013, 4:00 PM

MONDAY, Oct. 21 (HealthDay News) -- Experts have long suspected that breast milk may have the power to prevent babies from getting infected with HIV, and new research gives insight into why that might be so.

Researchers say they've discovered a component of breast milk that appears to kill the virus that causes AIDS, potentially preventing some babies from becoming infected by their mothers.

"Even though we have anti-retroviral drugs that can work to prevent mother-to-child transmission, not every pregnant woman is being tested for HIV, and less than 60 percent are receiving the prevention drugs -- particularly in countries with few resources," study senior author Dr. Sallie Permar, an assistant professor of pediatrics at Duke University, said in a university statement. "There is still a need for alternative strategies to prevent mother-to-child transmission, which is why this work is important."

The protein the researchers pinpointed, known as Tenascin-C or TNC, wasn't previously suspected to have germ-fighting abilities. The researchers reached their conclusions after testing samples of breast milk from uninfected women to see if it could combat HIV strains.

"TNC is a component of the 'extracellular matrix' that is integral to how tissues hold themselves together," Permar said. "This is a protein involved during wound healing, playing a role in tissue repair. It is also known to be important in fetal development, but its reason for being a component of breast milk or its antiviral properties had never been described."

Future research should examine whether the protein works with other components of breast milk to fight HIV, she said.

Dr. Barton Haynes, director of the Duke Human Vaccine Institute, added: "The discovery of the HIV-inhibiting effect of this common protein in breast milk provides a potential explanation for why nursing infants born to HIV-infected mothers do not become infected more often than they do."

"It also provides support for inducing inhibitory factors in breast milk that might be even more protective, such as antibodies, that would completely protect babies from HIV infection in this setting," Haynes said.

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Scientists Uncover Breast Milk's Potential Secret Weapon Against HIV

Things seemed so peachy keen for Glenn and Maggie when season 4 of The Walking Dead began. They were engaged and having a grand ol time sleeping in the watch tower. But now theres a killer virus going around. Glenn has been exposed to people that are sick and Maggie has not. So how exactly is the farmers daughter supposed to help while also keeping her safe distance?

Lauren Cohan, who plays Maggie, shed some light on the subject when she stopped by the Entertainment Weekly Radio studios (SiriusXM, channel 105) to talk all things Walking Dead. She is terrified that this could be the end and just goes to action stations, says Cohan of Maggies reaction to the situation. Thats all she can do. She just has to keep her s together. Its torture being separated form him and being sort of amputated. Its a very intense ride.

Cohan also weighs in on Carol 2.0, which was in full force in episode 2. The whole transformation for Melissas character is so much fun. And it has not even begun, lets just leave it at that. Its really awesome. To hear more from Cohans EW Radio interview, just click on the audio player below. And for more interviews with The Walking Dead cast over the next few weeks, tune to SiriusXM, Channel 105.

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'Walking Dead': Lauren Cohan talks Maggie