To test the hypothesis that starting human immunodficiency virus (HIV) antiretroviral therapy (ART) within hours of birth can possibly lead to remission in some children with HIV, researchers at Columbia University Mailman School of Public Health designed a trial in a group of newborns with HIV who started ART within 14 days of birth. The results showed that about 75 percent of infants attained viral suppression on ART; but only 52 percent attained and sustained suppression on ART. Success rates were similar in infants starting ART less than two days old (51 percent) and between 2 and 14 days after birth (54 percent). Findings are in E-Clinical Medicine.
“Very early treatment in newborns may not have to mean within hours of birth,” said Dr. Louise Kuhn, Columbia Mailman epidemiology professor. “We learned that we must be more attune to basing decisions about how quickly to start ART on optimizing maternal adherence with treatment rather than with just focusing on speed.”
The study was designed shortly after the report of the infant in Mississippi who started ART within 30 hours of birth and who was able to maintain viral suppression off treatment for over 2 years. This led to optimism that ART started within hours of birth may lead to protection of critical immune processes, making remission possible.
The analysis included 73 children born with HIV infection and ART initiated within 14 days. The initial regimen consisted of nevirapine, lamivudine and zidovudine; nevirapine was later replaced with lopinavir-ritonavir.
“We concluded that very early ART on its own is unlikely to lead to remission in a sizable minority of early-treated infants,” said Dr. Kuhn. “Moreover, most of the study participants’ caregivers live in impoverished economic circumstances with complex social problems and experience a high degree of HIV-related stigma.”Friday Letter Submission, Publish on January 17