HIV undetectable in infants given early ART

Starting combination antiretroviral therapy within 72 hours of birth significantly reduced HIV reservoirs.

Early cART Tx reduced proviral HIV-1 DNA in infants
Early cART Tx reduced proviral HIV-1 DNA in infants

Starting combination antiretroviral therapy soon after birth in newborns whose mothers had HIV reduced viral load to undetectable levels, according to researchers.

"Our findings suggest that starting combination treatment within 72 hours of birth may significantly reduce the amount of HIV in the body," Ari Bitnun, MD, MSc, FRCPC, of the Hospital for Sick Children in Toronto, Canada, and colleagues reported in Clinical Infectious Diseases.

They performed chart reviews of 136 children with sustained virologic suppression who had received combination treatment within 72 hours of birth at three Canadian medical centers to determine how treatment effected HIV-1 reservoirs.

Overall, 12 infants had confirmed HIV infections from vertical transmission. Three to seven years later, eight of these 12 children had evidence of active infection based on detection of the virus in standard viral load blood tests, whereas four children had undetectable viral loads on HIV serology, HIV-1‐specific cell‐mediated immune responses and ultrasensitive viral load tests.

Among the eight children with detectable HIV, history was positive for incomplete adherence to therapy at some point during follow-up. The four children with undetectable viral loads reported high adherence to ART.

The researchers also performed a series of highly sensitive tests to determine if latent virus was present in the blood cells. They were unable to detect latent virus in three of the four children. In the fourth, virus was cultured from blood cells at an extremely low level (0.1 infectious units/106 CD4+ T-cells).

“Given that it is not possible to examine every cell in each infant, a structured treatment interruption may be the only practical way to determine if HIV‐1 eradication or functional cure can be achieved in such children,” the researchers wrote.

References

  1. Bitnun A. Clin Infect Dis. 2014; doi: 10.1093/cid/ciu432
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