From The Floor
A Cure for HIV? What Nurses Need to Know
The successful treatment of an HIV-positive baby offers reason for hope, but it is too early to celebrate the demise of AIDS
One of the costs of practicing our profession in the Golden State is a requirement for continuing education. As every California RN knows, we must complete a minimum of 30 hours every two years. The goal is to encourage RNs to keep abreast of the latest developments, trends and changes in our areas of practice.
Since many of us work more than 40 hours a week, often under very stressful conditions, some nurses find the continuing education requirement onerous. However, 15 hours a year is not really so difficult, particularly considering the vast arrays of courses and seminars offered and the growing availability of online courses. More importantly, we should not overlook the importance of staying current on the ever-changing landscape of nursing, medicine and healthcare, especially with the implementation of the Affordable Care Act.
Even outside of my own continuing education requirements, I’ve always been a voracious reader. My children often joke that if you leave a newspaper or magazine lying around, you risk finding it full of holes from where I’ve cut out articles on healthcare and other topics I found interesting. Reading and listening to the news, both local and national, provides me with a wealth of information that helps me become a better, more informed nurse, advocate and activist.
Like many nurses, I am regularly peppered with questions from friends and neighbors about the newest health breakthroughs or latest health-related news. A typical example was the announcement earlier this year that an infant had been cured of HIV.
Let me recap the story so far: A study was presented at the Conference on Retroviruses and Opportunistic Infections in March regarding a baby born in rural Mississippi to a mother who, shortly after the baby’s birth, was found to be HIV-positive. Since the mother had not undergone the prenatal treatments usually recommended for pregnant women with HIV, the baby was aggressively treated with antiretroviral drugs starting around 30 hours after birth.
According to Hannah Gay, M.D., the pediatrician who treated the infant, the baby’s virus levels were fairly low (about 20,000 copies per milliliter), suggesting that the infection may have occurred in the womb rather than during delivery.
The baby’s viral levels rapidly declined with treatment and were undetectable by the time she was a month old. That remained the case until the baby was 18 months old, at which point the mother stopped coming into the hospital and the baby stopped receiving treatment.
When mother and child returned to the hospital five months later, Gay expected that the baby would have high viral levels, but that turned out not to be the case. Suspecting a laboratory error, Gay ordered additional tests, but all came back negative.
Gay contacted Katherine Luzuriaga, M.D., an immunologist at the University of Massachusetts, who was working with Deborah Persaud, M.D., of Johns Hopkins and others on a project, sponsored by AMFAR, to document possible pediatric HIV cures. A battery of sophisticated tests performed on the baby found tiny amounts of viral genetic material, but no virus able to replicate, not even lying dormant in areas of the body that are known reservoirs for HIV.
When a Cure is Not a Cure
Since the United Nations estimates that 330,000 babies were newly infected with HIV in 2011 alone, it’s little wonder that newspapers across the country and around the world responded to the news from the conference with optimistic headlines announcing that a baby had been cured of HIV.
I read those stories with the cautious reserve I’ve developed over decades of involvement in HIV/AIDS. Too many times, I’ve felt a surge of hope at such announcements, only to see those hopes dashed. Therefore, I was not surprised when the headlines changed from “baby with HIV is cured” to “baby with HIV is functionally cured.”
Is there really much difference between “cured” and “functionally cured”? For those of us in the healthcare field, the two are worlds apart.
In a recent article in the International Journal of Collaborative Research on Internal Medicine and Public Health, HIV specialist Matin Ahmad Khan, MBBS, Ph.D., distinguishes between a functional cure — “long-term control of HIV in the absence of HAART [highly active antiretroviral therapy]” — and what he calls a “sterilizing cure, which is the elimination of all HIV-infected cells.” A functional cure is an important step, but it isn’t the end of the road by any means.
At present, there has only been one case where a patient has been declared “cured” of HIV: Timothy Ray Brown, sometimes known as “the Berlin Patient,” after the city where he was treated. Diagnosed with HIV in 1995, Brown was diagnosed with leukemia in 2006 while living in Germany. Brown received a bone marrow transplant from a donor with a rare genetic mutation that has been known to provide natural resistance to HIV and which Gero Hütter, M.D., the doctor who performed the transplant, posited might be transferred to Brown.
Five years after the transplant and without taking antiretroviral drugs, tests seem to confirm that Brown is still HIV-free, but some experts still remain very cautious about using the word “cured.”
None of this means the results reported at the conference in March should be discounted or ignored, but it does underscore how crucial it is for healthcare professionals such as nurses to know all the facts so that we are better able to interpret such cases for the general public.
The average person may not grasp the nuances of complex medical developments or the potentially enormous significance of a seemingly trivial shift in wording. However, the public expects us to know the difference and be able to explain it in terms the average person can understand. It’s one of our most basic obligations as nurses.
For that reason, we should look at continuing education not as an onerous, pro-forma licensure requirement, but as an opportunity to expand our knowledge, enhance our skills and, most importantly, live up to the enormous trust that the public has in us and our profession.
Geneviève M. Clavreul RN, Ph.D., is a healthcare management consultant who has experience as a DON and as a lecturer on hospital and nursing management.
Photos above, pictured from left: Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi; Katherine Luzuriaga, M.D., an immunologist at the University of Massachusetts; and Deborah Persaud, M.D., a virologist at Johns Hopkins Children’s Center in Baltimore, Md. Photo credits: AP, University of Massachusetts Medical Center, Reuters.
This article is from workingnurse.com.