March 8, 2013

1. The case of the Mississippi baby means we’re close to curing AIDS.

What happened with the baby girl in Mississippi was remarkable, but it’s not clear what lessons the case has for improving the health of other children or fighting the epidemic generally. The infant never developed AIDS, the disease caused by HIV. And scientists are debating whether she was truly infected with the virus.

Craig Timberg is a national technology reporter for The Post. View Archive

Here’s what is known: The baby’s mother was infected and had not had prenatal care. After delivery, the baby had some HIV in her blood. Aggressive treatment with a combination of powerful drugs drove the virus to undetectable levels. Doctors were surprised, however, when a long break in treatment (after the mother started missing appointments) didn’t lead to a resurgence of HIV. The virus remained undetectable, though it’s too soon to know if it is permanently gone.

This case was very unusual. HIV infections in pregnant women are routinely detected during prenatal care, allowing time to start effective drug regimens that keep the virus from infecting babies. Such strategies are all but universal in wealthier nations and now reach more than half of infected women in the parts of Africa where HIV is widespread. But given how cheap and easy it is to prevent infection in infants, it’s a tragedy that more than 300,000 contract HIV each year. The developments in the Mississippi case are unlikely to have a direct impact on most of them.

2. AIDS is the leading killer of babies worldwide.

Infant mortality is a scourge of poor nations. But AIDS is not the main cause. Diarrhea, pneumonia and malaria are. Together they are responsible for more than a third of the nearly 7 million deaths annually of children under age 5, according to UNICEF. AIDS is responsible for about 2 percent of those deaths. Even in the nations where HIV is most common, AIDS usually kills fewer babies than other diseases that can be treated using relatively inexpensive interventions, such as oral rehydration salts or antibiotics.

Every life is precious, and AIDS programs should not be shortchanged. But if the goal is saving young lives, there are other maladies that could be reduced dramatically with some low-tech investments. These include water treatment, nutrition programs and family-planning services, so mothers can control how many babies they bear. General medical care and sanitation go a long way toward creating healthy communities.

3. Mothers with HIV should never breast-feed.

A baby has a nearly 1 percent risk per month of contracting HIV from an infected mother who is breast-feeding, and many AIDS experts once believed that the risk of transmitting HIV during nursing made infant formula a better choice in almost all situations. That thinking has shifted in recent years with mounting evidence about the value of breast milk and the dangers of using formula in areas where clean water and a steady supply of formula aren’t reliably available.

A mother’s milk gives her baby essential nutrients and fluids — especially important in profoundly poor regions prone to drought — as well as antibodies that fight the diseases that are even more likely than AIDS to afflict babies. Infected mothers who live in developed countries are still urged not to breast-feed their babies. But where most of the world’s poorest babies are born and raised, forgoing mother’s milk can be more dangerous than the risk of contracting HIV during nursing.

4. Drugs are the key to preventing HIV’s spread.

The widespread provision of AIDS drugs — with crucial help from the U.S. government — has been one of the most stirring public health successes of our time, extending and improving the lives of millions of people. These medicines, when given to infected women before labor and to their newborns shortly afterward, also help prevent infection in babies. And, if started quickly enough, a short course of AIDS drugs can protect people recently exposed to HIV — such as rape victims and health professionals stuck with infected needles — from contracting the virus.

Yet for all their powers, the ability of these medicines to slow the sexual transmission of HIV — its main route across the planet — remains unclear. People whose HIV is treated effectively are much less likely to pass the virus to sexual partners, but in communities with easy access to AIDS drugs, risky behavior often arises because there is less fear of the disease.

There are some other powerful prevention tools. HIV thrives in regions where it’s fairly common to have more than one regular sexual partner at the same time, creating webs of interaction that the virus can follow from victim to victim. Condoms can help slow the spread, as can HIV treatment. But the most potent force in reducing infections, as discovered in Uganda, Zimbabwe and several other places, is lowering the number of sexual partners of the average adult.

Also remarkably effective is circumcision, an African tradition that had fallen out of favor in certain areas, including the ones now hit hardest by AIDS. Circumcised men are at least 65 percent less likely to contract HIV than uncircumcised men. Of course, fewer infected men means fewer infected women — and fewer infected babies.

5. AIDS can’t be defeated.

Reports about the Mississippi baby have garnered so much attention in part because people fear that the epidemic is out of control. U.N. officials estimate that 34 million people have HIV, with 2.5 million new infections and 1.7 million deaths in 2011 alone. Even in the United States, with its routine access to modern medical care, there were an estimated 8,300 AIDS deaths in 2010.

But there is room for optimism. The spread of HIV peaked in 1997, and the pace of new infections has been falling gradually ever since. Deaths have peaked in recent years, both because of declining infection rates and better access to treatment. This has happened even though the long, expensive search for a vaccine remains far from fruition.

To defeat AIDS, much more needs to be done to curb infection rates and to get medicine to those with HIV. And while debate remains fierce over what prevention measures are most important, there is consensus that some combination of what’s currently available can eventually overcome the epidemic.

These include making male circumcision safe and available, encouraging adults to have fewer sex partners, making condoms more accessible, providing clean needles to drug users and treating infected people before they develop full-blown AIDS. To keep babies safe from this terrible disease, the most important priority is to keep women from contracting HIV in the first place.

In public health, curing diseases is great. Preventing them is even better.

timbergc@washpost.com

dhalpe@gmail.com

Read more from Outlook, friend us on Facebook, and follow us on Twitter.

Craig Timberg and Daniel Halperin are the authors of “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It,” released in paperback this month. Timberg covers technology for The Washington Post. Halperin is a professor of epidemiology at the Ponce School of Medicine and Health Sciences in Puerto Rico.

Doctors last Sunday announced that by giving powerful drugs to the baby of an HIV-infected mother in Mississippi shortly after her birth, they had apparently eliminated the virus from her body. The news fueled renewed optimism about the prospects of finally curing AIDS. But a true cure is almost certainly years away.