On Monday, March 4, the world woke to the welcome news that doctors in the US state of Mississippi had made medical history after presiding over the first documented functional cure of a baby born with HIV.The extraordinary outcome is the chance result of two decisions, by turns incisive and unorthodox, first by staff at the University of Mississippi Medical Centre (UMMC), then by the baby's mother. Presenting the case at the Conference on Retroviruses and Opportunistic Infections in Atlanta, Georgia, Johns Hopkins' virologist Deborah Persaud detailed how the baby's mother was unaware she was HIV-positive until the results of a routine test came back during the later stages of labour, by which time she was too close to delivery to risk using antiretrovirals. Given the substantial risk of mother-to-child transmission, the medical centre's paediatric HIV specialist Hannah Gay opted for an aggressive course of treatment: a three-drug cocktail of intravenous zidovudine, lamivudine, and nevirapine (replaced with lopinavir plus ritonavir at 7 days) at a therapeutic rather than a prophylactic dose and, crucially, given just 30 h after birth.
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