Doctors treating a HIV-infected baby in Milan, Italy, say that giving drugs within hours of infection is not a cure.
The newborn infant cleared the virus from their bloodstream, but HIV re-emerged soon after antiretroviral treatment stopped.
Doctors had hoped rapid treatment would might prevent HIV becoming established in the body.
Experts said there was “still some way to go” before a cure was found.
Drug treatments have come a long way since HIV came to global attention in the 1980s and infection is no longer a death sentence.
However, antiretrovirals merely clear the virus from the bloodstream leaving reservoirs of HIV in other organs untouched.
The hope was that acting before the reservoirs formed would be an effective cure.
Drug treatments have come a long way since HIV came to global attention in the 1980s and infection is no longer a death sentence
Doctors at the University of Milan and the Don Gnocchi Foundation in the city have reported a case, in the Lancet medical journal, of a baby born to a mother with HIV in 2009.
Drug treatment started shortly after birth and the virus rapidly disappeared from the bloodstream. HIV was undetectable at the age of three.
The doctors said: “In view of these results, and recent reports of apparent cure of HIV infection, and in agreement with the mother, we stopped antiretroviral therapy.”
For one week everything seemed fine, but in the second week, after treatment stopped, the virus had returned.
In July 2014, a baby girl in the US born with HIV and believed cured after very early treatment was found to still harbor the virus.
Doctors said tests on the four-year-old child from Mississippi indicated she was no longer in remission.
The Mississippi girl had appeared free of HIV as recently as March, without receiving treatment for nearly two years.
Only one person has 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.
Timothy Ray Brown has shown no signs of infection for more than five years.
According to new research, early HIV treatment may not cure the virus as it can rapidly form invulnerable strongholds in the body.
A baby was thought to have been cured with treatment hours after birth, but the virus emerged years later.
Monkey research, published in the journal Nature, suggests untouchable “viral reservoirs” form even before HIV can be detected in the blood.
Experts described it as a “sobering” and “striking” finding.
Reservoirs of HIV in the gut and brain tissue are the massive obstacle in the way of a cure.
Remarkable progress in developing antiretroviral drugs means HIV can be kept in check in the bloodstream and patients have a near-normal life expectancy.
But if the drugs stop, the virus will emerge from its reservoirs.
Early HIV treatment may not cure the virus as it can rapidly form invulnerable strongholds in the body
International research is focused on flushing the virus out of its reservoirs, but there had been hope that early treatment could prevent them forming in the first place.
In the study, rhesus monkeys were infected with the monkey equivalent of HIV – simian immunodeficiency virus (SIV).
The monkeys were then given antiretroviral drugs as early as three days or as late as two weeks after infection.
Treatment stopped after six months, but the virus re-emerged irrespective of how quickly antiretroviral treatment started.
It showed that viral reservoirs formed incredibly early in the course of the infection.
Dan Barouch, professor of medicine at Harvard Medical School, said: “Our data show that in this animal model, the viral reservoir was seeded substantially earlier after infection than was previously recognized.
“We found that the reservoir was established in tissues during the first few days of infection, before the virus was even detected in the blood.”
It had been believed a baby girl born with HIV had been cured after very early treatment.
The “Mississippi baby” was given HIV drugs for the first 18 months of life, but then they were stopped.
Initially the virus did not return and there was hope she had been effectively cured.
But last week it was announced that the girl, now four years old, was no longer in remission after nearly two years off the drugs.
“The unfortunate news of the virus rebounding in this child further emphasizes the need to understand the early and refractory viral reservoir that is established very quickly following HIV infection in humans,” Prof. Dan Barouch added.
Kai Deng and Robert Siliciano, of the School of Medicine at Johns Hopkins University, in Baltimore, Maryland, commented: “These data indicate that the viral reservoir could be seeded substantially earlier than previously assumed, a sobering finding that poses additional hurdles to HIV eradication efforts.
“Although early treatment may not prevent reservoir seeding, it has been consistently shown to reduce the size of the reservoir.”
They highlighted significant differences between these experiments and the human HIV infection, but concluded that the findings “suggest new approaches in addition to early treatment will be necessary to eradicate HIV infection”.
