Next to Ryan White, he's the most famous child in the history of AIDS. But though the baby's name is still unknown in deference to his parents' wishes, the name of the doctor who discovered the first recorded case of an HIV-infected individual vanquishing the virus is now known around the world.
When he was born prematurely to a mother diagnosed HIV-positive, he was just another infant at risk. But because he was born at the UCLA Medical Center, he became one of UCLA pediatrician Yvonne Bryson's babies. A principal investigator for the Los Angeles Consortium for Mothers and Children, heading a number of studies on HIV-infected babies and their mothers at L.A.-area hospitals, including UCLA, Bryson and her colleagues took blood from the baby's umbilical cord and sent it to Irvin Chen's lab at the UCLA AIDS Institute. The boy's cord blood was clean — a good sign, but no more than that. Cord blood can only give evidence of infection before birth. The real hurdles to clear would come in the next few months.
Though Bryson and her colleagues have since found a way to cut the waiting time by culturing the cells that harbor the virus and providing them with the nutrients the virus needs to grow, in the mid-1980s the testing process took months. In this boy's case, when they cultured his cells again, Bryson found the virus. Another test at 51 days came up with the same result; the virus was in the blood cells and in the plasma.
The task of telling the boy's family fell to Bryson. "When you go through the process of telling them the baby's infected, it's an emotional thing for everybody," she says. "But this mother was always an optimist." But Bryson had little hope. So she simply put the baby's blood samples in a refrigerator and went back to work. That's not to say she stopped caring: "Like the others, I've followed him since the day he was born." As part of the routine follow-up, the boy was checked again on his first birthday, to find out if he was still carrying his mother's HIV antibodies, or producing his own. What wasn't routine was the result — negative. "We thought that was a mistake, and we did it again." Again, the results were negative.
Bryson's team went back to their earlier testing to culture the virus from the boy's blood and got nothing — proof the baby had been infected, that the infection had spanned more than a month's time and he was now virus-free. It was something Bryson had heard about, but only anecdotally.
To prove that the samples hadn't been contaminated, Chen took a close genetic look at the baby's virus. When the DNA from the two HIV samples taken a month apart were compared, it was clear they were, essentially, the same virus. The chance that two samples could be contaminated by the same virus was next to nonexistent. Chen then compared those DNA sequences to bits of DNA from the other strains of HIV studied in his lab, the potential contaminants. They didn't match.
After nearly four years of additional testing, the team was ready to tell the world last spring. And still no answers — that could take another four or five years, says Chen. "One possibility is that the mother had a very weak strain of HIV, and it was not able to get a foothold in the baby. The second is the baby's immune system or the mother's immune system was strong enough to prevent the virus from establishing itself."
Now 5, the boy is a sturdy, healthy kindergartner. And what his body did may not be entirely unique. Indeed, Chen and Bryson are following another case of what appears to be viral clearance in a 4-year-old girl. And they've put out the call to their colleagues to come forward with all those anecdotal cases ignored in the past. "This has really opened up a lot of people's minds," says Bryson.
— Lori Oliwenstein |