Starting Antiretroviral Therapy Immediately After Birth Can Help Infants Born With HIV, New Research Shows

The results of a clinical trial showed that four children remained free of detectable HIV for over a year after pausing their antiretroviral therapy (ART) with the purpose of seeing if they could achieve remission.

The trial involved starting an ART regimen within 48 hours of birth, after which the babies were “closely monitored for drug safety and HIV viral suppression.” The study, which took place over several countries across multiple continents, identified a “small subset of children” who “achieved sustained HIV suppression and met other predefined study criteria for interrupting ART.”

Of the six five-year-old children who were studied, “four of the six children experienced HIV remission, defined as the absence of replicating virus for at least 48 weeks off of ART. One of them experienced remission for 80 weeks, but then their HIV rebounded to detectable levels. Three others have been and remain in remission for 48, 52, and 64 weeks, respectively. However, two children did not experience remission, and their HIV became detectable within three and eight weeks after ART interruption, respectively.” These children experienced symptoms of mild acute retroviral syndrome (ARS), but the ARS and additional white blood deficiency “resolved either prior to or soon after restarting ART.”

The researchers characterize the findings as showing “that very early ART initiation has varying but favorable outcomes on control of HIV.” Now, research turns to how newer, more potent antiretroviral drugs could impact the possibility of remission, and the identification of biomarkers “to predict the likelihood of HIV remission or rebound following ART interruption.”

According to the NIH, “advances in ART have significantly reduced perinatal HIV transmission, when a child acquires HIV while in the uterus, during birth, or through consumption of milk from a lactating person. If transmission does occur, children must take lifelong ART to control replication of the virus and protect their immune systems from life-threatening complications. Typically, interruption in treatment will lead to rapid resumption of HIV replication and detectable virus in the blood within weeks.” Case reports of an infant in Mississippi who remained in remission after being taken off ART spurred researchers to undertake this trial.

NIH’s website has the release.