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.

GETTY
Show Hide image

How the Night Tube could give London’s mice that Friday feeling

London Underground’s smaller inhabitants might be affected by the off-squeak service – and learn when the weekend’s coming up.

What will the mice who live in the Tube network make of the new all-night service? Half a million of them are thought to have made the London Underground their home – and will be in for a surprise when the Victoria and Central lines keep running this weekend.

The Londonist is concerned the mice “are unlikely to get any sleep” with the new Night Tube, and may move to the District line instead. Yet a number of scientists point out to the New Statesman that mice are nocturnal creatures, most likely to sleep while the lights are on and the trains are running.

So will they get on board with the change – or make a run for different platforms on other lines?

The bad news:

“When the Tube’s away, the mice will play,” is how the rhyme (almost) goes. 

Many have come to know  and even love  the mischiefs of the mice who stream off the tracks and out of the tunnels as the stations close at night, in search of discarded morsels of Maccy D. And until now, they’ve had a good few hours to conduct such galavanting in peace. But the new system means they will have to re-structure their sleep and foraging cycles, or “circadian rhythms”. 

“The presence of night trains should upset several of these entrainment factors (or zeitgebers = time givers) leading to disturbances in their behaviours,” explains Professor Patrick Nolan, from MRC Harwell, an international centre for mouse genetics. 

“When you fly across the Atlantic, for example, it takes a few days to adapt, you feel a bit groggy, don't perform as well as you usually do, don't eat well, etc. You soon adapt to the change. But if there are constant disruptions like this, the effect may be more severe and long-lasting. And this is how the schedule changes in the Underground might affect the resident mice.” 

So it's the constant switching between the week and weekend schedules that could leave the mice  and Tube drivers  most cheesed off. Agoraphobia (fear of open spaces) and photophobia (sensitivity to light) are two possible effects of the resulting anxiety, and their mating patterns and liver functions are also likely to be disturbed.

The good news:

Yet it is unlikely mice will be leaving the Night Tubes for good. 

The more time we humans have to drop our dinners, the larger the menu becomes for the mice (researchers tell me that strawberry milk and Wheetos are particularly favoured fare).

“Mice are active most of the time – so more trains at night hours will not make such a difference to them,” say the RSPCA’s wildlife officers. “In fact, it may help as it may provide more foraging opportunities.”

They’ve also faced worse before. The London Transport Museum reminds us that, during the Second World War, cats were employed to counter vermin on the network (spot the cat in the 1940s TfL workers' canteen below).


Credit: London Transport Museum

For Dr Samuel Solomon at UCL, there is plenty to suggest the mice will successfully adapt. His study of mouse reflexes shows how they respond to various visual stimuli – and can start running within one-tenth of a second. “There might be cues they pick up – if people clean the station differently on Fridays, for instance.”

The tracks’ electric current may no longer be entirely switched off (if it ever was), but their whiskers’ sensitivity to vibrations could help them juggle their escapades to fit around the Night Tube’s less frequent service.

What Dr Soloman can’t yet predict is whether the mice will start to anticipate that Friday feeling: “It will be interesting to see whether they can learn that Friday is Friday”.

All in all, the Tube mice seem well set for the Night Tube’s new challenge. Who knows, they may soon gain the confidence of their 24/7 brothers in New York – and start ordering take-out...

India Bourke is the New Statesman's editorial assistant.