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Şifremi Unuttum

HIV Tedavisinde Kötü Haber

HIV tedavisinde kötü haber

AA Giriş Saati : 11.07.2014  14:23

ABD’de yeni bir tedavi yaklaşımının ardından HIV infeksiyonundan kurtularak tamamen iyileştiği düşünülen çocuğun kanında tekrar virüse rastlandığı bildirildi.

Amerikan Ulusal Sağlık Enstitüleri (NIH) tarafından yapılan açıklamada, doğumundan hemen sonra 18 ay ilaç tedavisi uygulanan, tedavinin kesilmesinden sonraki 2 yıl boyunca kanında HIV‘e rastlanmayan çocukta tekrar HIV virüsü saptandığı belirtildi.

Kötü haber, tedaviye erken ve güçlü ilaçlarla başlamayı öngören yeni yaklaşımın, bir kere vücuda yerleştikten sonra kalıcı hale gelen HIV infeksiyonunun tamamen iyileştirilebileceği umutlarına darbe indirdi.

NIH bünyesindeki Ulusal Alerji ve Bulaşıcı Hastalıklar Enstitüsü’nden (NIAID) yapılan açıklamada da yeni gelişmenin hem çocuğu hem de tedavisini gerçekleştiren ekibi düş kırıklığı uğrattığı kaydedildi.

Yeni tedavi yaklaşımı konusunda araştırmalara fon sağlayan kuruluşlar arasında yer alan NIAID’in Direktörü Anthony S. Fauci, “Bu yeni gelişme, bilimsel olarak bize HIV infeksiyonunun zorlukları ve virüsün vücutta gizlendiği yer hakkında hala öğrenmemiz gerekenler olduğunu gösteriyor. Kurumumuz, HIV infeksiyonun çare bulunmasını amaçlayan araştırmaları ileriye götürmeye kararlıdır” dedi.

Kısaca HIV olarak adlandırılan İnsan Bağışıklık Yetmezliği Virüsü, ilaçlarla kontrol altına alınmaması durumunda AIDS olarak da bilinen, Edinilmiş Bağışıklık Eksikliği Sendromu adlı tedavisi mümkün olmayan ölümcül hastalığa yol açıyor.

MİSSİSSİPPİ BEBEĞİNİN HİKAYESİ

2010’da ABD’nin Mississippi eyaletindeki bir klinikte HIV taşıyan annesinin erken dünyaya getirdiği bebek, uygulanan yeni tedavi yaklaşımı sayesinde tamamen iyileştiği düşünüldüğü için tıp literatürüne “Mississippi bebeği” olarak geçmişti.

HIV taşıdığından habersiz annede, doğumun ardından yapılan testlerde virüse rastlanması üzerine doktorlar doğduktan 30 saat sonra bebeğe üçlü antiretroviral sıvı ilacı tedavisine başlamıştı.

Tedaviye başlandıktan birkaç gün sonra kanında HIV bulunduğu teyit edilen bebek, iki haftalık olduktan sonra hastaneden taburcu edilmiş ve ilaç tedavisi evde sürdürülmüştü.

Ailesinin 18 aylık olduktan sonra ilaç tedavisine getirmemesi üzerine tedavisi bir süre kesilen bebekte 5 ay sonra yapılan taramalarda kanında HIV seviyesinin belirsiz ölçülerde (mililitrede 20 kopya) olduğu görülmüş ve vücutta faal olarak çoğalan virüs bulunduğunun göstergesi olan HIV antikorlarına da rastlanmamıştı.

HIV RUTİN SAĞLIK KONTROLÜNDE BELİRLENDİ

NIH açıklamasına göre, ilaç tedavisinin sonlandırılmasının ardından geçen 2 yılı aşkın süre boyunca sağlıklı kalmayı sürdüren ve 4 yaşına giren çocukta bu ay içinde yapılan rutin sağlık kontrolleri sırasında HIV’in tekrar ortaya çıktığı anlaşıldı.

Sağlık kontrolünde kanında belirgin seviyelerde (mililitrede 16 bin 750 kopya) HIV virüsü bulunduğu belirlenen çocukta 72 saat sonra yapılan virüs yükü testi de kanda mililitrede 10 bin 564 kopya virüs olduğunu teyit etti. Kanda HIV antikorlarının da bulunduğunu gösteren test, normal bağışıklık sisteminin tamamlayıcı parçası olan CD4+ T hücrelerinde de azalma saptadı.

Sonuçlar üzerine tekrar ilaç tedavisine alınan çocuğun bugüne kadar hiçbir yan etkisi görülmeyen ilaçları tolere ettiği belirtilen açıklamada, tedavi sayesinde kandaki virüs seviyelerinin düştüğü kaydedildi.

‘Cured’ HIV Baby Still Infected Say Doctors


 

 

 

 

 

 

 

 

 

 

 

 

 

The Huffington Post UK  |  By Posted: 11/07/2014 10:23 BST  |  Updated: 11/07/2014 10:59 BST

A Mississippi baby that had reportedly been ‘cured’ of HIV has been confirmed as still having the virus after traces were found in a routine bloody test.

Doctors had believed that the four year old was cured of the virus after she was given an extreme course of medication immediately after birth.

After nearly two years without medication doctors carried out a routine blood test and discovered that the virus was still in her bloodstream.

Despite using concentrated antiretroviral drugs the virus can hide in the gut and the brain, laying dormant until the treatment stops when it’ll start multiplying again.

Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases said:

“It’s obviously disappointing, but I was not surprised. I’ve been chasing these reservoirs for the last 25 years, and I know this virus has a really uncanny way of hiding itself.””We’ve got to go back and look at the trial’s design,”

The Mississippi baby isn’t the first human to be declared ‘cured’ of the virus, however doctors are remaining understandably skeptical about making such claims especially after as significant a relapse as this.

Dr Rosemary Gillespie, Chief Executive at Terrence Higgins Trust, a HIV and sexual health charity said:

“This story is a disappointing reminder of just how far we have to go to defeat HIV. It is a remarkably tenacious virus, which exploits a number of ‘hiding places’ inside the body to survive. Though daily drug treatments can keep it under control, once someone has contracted HIV they will have it for life. Using condoms remains the best strategy to avoid infection.”

“We’re fortunate in the UK to have a world-leading antenatal screening programme, which means that women living with HIV can have children safely, with a very small risk of the virus being passed on. In the western world we have the tools to ensure that no child is born with HIV, so cases like this are both rare and concerning.”

HIV re-emerges in ‘cured’ Mississippi girl

10 July 2014 Last updated at 20:44 GMT

A baby girl in the US born with HIV and believed cured after very early treatment has now been found to still harbour the virus.

Tests last week on the four-year-old child from Mississippi indicate she is no longer in remission, say doctors.

She had appeared free of HIV as recently as March, without receiving treatment for nearly two years.

The news represents a setback for hopes that very early treatment of drugs may reverse permanent infection.

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told US media the new results were “obviously disappointing” and had possible implications on an upcoming federal HIV study.

“We’re going to take a good hard look at the study and see if it needs any modifications,” he said.

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Analysis

By James Gallagher, Health editor, BBC News website

There was huge hope that the “Mississippi baby” would live a life free of the HIV.

Antiretroviral drugs can keep the virus in check in the bloodstream, but HIV has hiding places – known as reservoirs – in the gut and brain.

If treatment stops, then the virus emerges from its reservoirs and begins its assault afresh.

Doctors had hoped that starting drug treatment within hours of birth would prevent the reservoirs forming.

This seems not to have been the case.

This case was never going to lead to an HIV-cure for infected adults, who begin treatment months or years after infection.

The Mississippi baby has become a reminder of how difficult HIV is to defeat and how distant a cure really is.

BBC News: A cure for HIV?

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Genetic mutation

The child, nicknamed the “Mississippi baby”, did not receive any pre-natal HIV care.

Because of a greater risk of infection, she was started on a powerful HIV treatment just hours after labour.

She continued to receive treatment until 18 months old, when doctors could not locate her. When she returned 10 months later, no sign of infection was evident though her mother had not given her HIV medication in the interim.

Repeated tests showed no detectable HIV virus until last week. Doctors do not yet know why the virus re-emerged.

A second child with HIV was given early treatment just hours after birth in Los Angeles in April 2013.

Subsequent tests indicate she completely cleared the virus, but that child also received ongoing treatment.

Only one adult is currently believed to have been cured of HIV.

In 2007, Timothy Ray Brown received a bone marrow transplant from a donor with a rare genetic mutation that resists HIV. He has shown no signs of infection for more than five years.

Mississippi baby thought cured of HIV no longer in remission

BY JULIE STEENHUYSEN

Thu Jul 10, 2014 4:17pm EDT

(Reuters) – A toddler thought to have been cured of HIV now has detectable levels of the virus in her blood, the child’s doctors and U.S. health officials said on Thursday.

The Mississippi child’s stunning story, first disclosed at a medical meeting in March 2013, was the first account of an HIV-infected infant achieving what appeared to be a cure after receiving aggressive drug treatment within the first 30 hours of life.

The case raised hopes that more of the roughly 250,000 children who are born each year infected with the human immunodeficiency virus, which causes AIDS, might have a shot at a cure.

Those hopes were dashed when the child’s doctors discovered last week that the HIV virus had begun replicating, Dr Anthony Fauci, director of the National Institute of Allergy and Infections Diseases, said at a press conference on Thursday.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care and the HIV/AIDS research community,” Fauci said in a statement.

The girl, now 4, was born prematurely in a Mississippi clinic in 2010 to an HIV-infected mother who had received no prenatal care.

After her birth, the child was rushed to the University of Mississippi Medical Center, where Dr Hannah Gay, a pediatric HIV specialist, decided to take aggressive action, offering the newborn a three-drug cocktail of powerful HIV medications. Normally, children suspected of HIV infection are given a milder course of treatments until tests can confirm the infection.

The child remained on treatment for 18 months, then stopped coming in for treatment. When she returned to the medical center some weeks later, the child showed no sign of the virus.

Since March, the child’s progress has been monitored closely, and until last week, she had gone 27 months without treatment. Tests during that time showed no evidence of the virus.

That changed during a scheduled check-up last week, in which doctors discovered the virus had begun to replicate. The girl is now being treated with anti-HIV drugs, treatments she will likely need to take for the rest of her life unless a cure can be found.

Gay described her disappointment as “a punch to the gut.”

The developments likely cast doubt about the prospects of a cure for an HIV-infected California baby. In March, that child’s doctors announced they had used the same approach and have found no trace of virus in the baby after nine months of treatment. Because that child is still being treated, however, the case was not classified as a cure.

Even so, Fauci said the Mississippi case remains important because it confirms that the baby was indeed infected, something that had been doubted, and that early and aggressive treatment helped prevent the virus from replicating.

Fauci in May had announced plans to study more children using that same technique, but he will be taking a “hard look” at the design of that study now.

(Reporting Julie Steenhuysen in Chicago; Additional reporting by Toni Clarke in Washington; Editing by Bill Trott and Leslie Adler)