Four things you should know about the HIV "cure" before you get too excited

The baby might not even have been infected in the first place.

The story everyone is talking about today is the HIV "cure" - the Mississippi baby who, after being blasted with a cocktail of anti-viral drugs at birth, is now, at two years old, apparently virus-free. But when reading the euphoric news stories about it here, here and here, you should bear the following in mind:

1. The baby may not even have been infected in the first place

Here's a weird section in the NYT version of the story. Have a read of the following two paragraphs - are the doctors certain or uncertain that the baby was infected?

“The one uncertainty is really definitive evidence that the child was indeed infected,” said Dr. Daniel R. Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital in Boston.

Dr. Persaud and some other outside scientists said they were certain the baby — whose name and gender were not disclosed — had been infected. There were five positive tests in the baby’s first month of life — four for viral RNA and one for DNA. And once the treatment started, the virus levels in the baby’s blood declined in the pattern characteristic of infected patients.

The tests are pretty good, but are not usually trusted as a basis for confirmed diagnosis at that early stage. It is normal practice to confirm positive tests at 6 weeks. But as this baby had already been treated by then, lowering its viral load (negative tests came back at 29 days), it would have been difficult to do this. There is a very small chance the baby was not infected.

The virus may not have yet taken a hold on the baby's cells in a permanent way. Here's the WSJ:

Cells in the baby "may have been infected—there was virus around," said Steven Deeks, an AIDS researcher at University of California at San Francisco. "But the cells being infected weren't the type that become long-lived reservoirs."

There is also a small chance the baby was immune to HIV anyway. Around 1 per cent of Caucasians in the US are naturally immune.

Now, these are small chances, but then this baby is an outlier. It was not part of a large study where such anomalies are ruled out. The scientists have said it is unlikely to be replicable. Any way you put it, the baby itself is an anomaly.

2. This "cure" has already been found, and has been used on newly-infected people since 1987. Even if the baby was infected, today's news would simply extend it to newborns.

Today's news applies only to babies. Newborns at that. And it's not really a new method - rather, it's the same idea as PEP: if you have only just been infected, you might avoid HIV if you are immediately given a large amount of anti-HIV drugs. What the scientists confirmed today is that, in terms of emergency treatment, newborns are the same as newly-infected people. 

Here's the NYT again:

“That goes along with the concept that, if you treat before the virus has had an opportunity to establish a large reservoir and before it can destroy the immune system, there’s a chance you can withdraw therapy and have no virus,” said Dr. Anthony S. Fauci, the director of the National Institute for Allergy and Infectious Diseases.

(Oh, and if you were wondering, someone has actually been cured of AIDs before. This was a man called Timothy Brown, a leukemia sufferer who received a bone-marrow transplant from a donor genetically resistant to HIV.)

3. This would not be breaking much ground in preventing HIV in newborns anyway, because we have a solution for that

In countries with access to top-notch medical care (ie western countries), the transference of HIV from mother to child is extremely rare. This is because mothers are treated with antiretroviral therapy during pregnancy - a very effective way of preventing HIV in newborns.

4. Newborns in countries without a solution for that probably wouldn't get this treatment anyway

In countries without access to top-notch medical care, there is no reason that this treatment would be available where antiretroviral pregnancy treatment isn't.

So what does the news mean? Well it means that a few babies in countries with access to this sort of care but whose mothers have somehow slipped through the net of normal practice can be saved. Joyous news. But not quite as joyous as everyone seems to be making out.

UPDATE: This blog originally said that HIV tests at birth couldn't be accurate, but this applies only to antibody tests. The tests on DNA/RNA, which were done in this case, have a greater (although not 100 per cent) degree of accuracy.

HIV cure: not necessarily.. Photograph: Getty Images

Martha Gill writes the weekly Irrational Animals column. You can follow her on Twitter here: @Martha_Gill.

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Buying into broadband’s bigger picture

Reliable internet access must be viewed as a basic necessity, writes Russell Haworth, CEO of Nominet.

 

As we hurtle towards a connected future, in which the internet will underpin most aspects of our daily lives, connectivity will become a necessity and not a luxury. As a society, we need to consider the wider benefits of enabling internet connections for all and ensure no corner of the county is left out of the digital loop.

Currently, despite government incentive schemes and universal service obligations, the rollout of broadband is left largely to the market, which relies on fixed and wireless network operators justifying deployment based on their own business models. The commercial justification for broadband deployment relies on there being sufficient demand and enough people to pay for a broadband subscription. Put flippantly, are there enough people willing to pay for Netflix, or Amazon? However, rather than depending on the broad appeal of consumer services we need to think more holistically about the provision of internet services. If road building decisions followed the same approach, it would equate to only building a road if everyone living in the area bought yearly gym membership for the leisure centre at the end of the new tarmac. The business case is narrow, and overlooks the far-reaching and ultimately more impactful benefits that are available.

Internet is infrastructure as much as roads are, and could easily prove attractive to a wider range of companies investing in digital technology who stand to gain from internet-enabled communities. Health services are one of the most compelling business cases for internet connectivity, especially in remote, rural communities that are often in the “final five per cent” or suffering with below average internet speeds. Super-fast broadband, defined as 30 Mbps, is now available to 89 per cent of UK homes, but only 59 per cent of rural dwellings can access these speeds.

We mustn’t assume this is a minority; rural areas make up 85 per cent of English land and almost ten million people (almost a fifth of the population) live in rural communities. This figure is rising, and ageing ‒ on average, 23.5 per cent of the rural population is over 65 compared to 16.3 per cent in urban areas ‒ and this presents complicated healthcare challenges for a NHS already struggling to meet demand. It goes without saying that accessibility is an issue: only 80 per cent of rural residents live within 4km of a GP’s surgery compared to 98 per cent of the urban population.

While the NHS may not have the resources to build more surgeries and hospitals, robust broadband connections in these areas would enable them to roll out telehealth options and empower their patients with healthcare monitoring apps and diagnostic tools. This would lower demand on face-to-face services and could improve the health of people in remote areas; a compelling business case for broadband.

We can’t afford to rely on “one business case to rule them all” when it comes to internet connectivity – the needs run far beyond Netflix and Spotify, and the long-term, economic and social benefits are vast. It’s time to shift our thinking, considering internet connectivity as essential infrastructure and invest in it accordingly, especially when it comes to the needs of the remote, rural areas of the country.

Russell Haworth joined Nominet as CEO in 2015. He leads the organisation as it develops its core registry business, explores the potential of new technologies in the global internet sector, and delivers on its commitment to ensuring the internet is a force for good.

This article was taken from a New Statesman roundtable supplement "The Internet as Infrastructure: Why rural connectivity is crucial to the UK’s success"

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