Very early HIV treatment in infants is feasible and safe and leads to a small reservoir of infected cells, two studies from Botswana and Thailand show. The findings offer hope that infants diagnosed and treated soon after birth will have a better chance of controlling HIV if future research leads to interventions that can control HIV without prolonged treatment – a so-called functional cure.
The findings were presented last week at the 25th Conference on Retroviruses and Opportunistic Infections in Boston.
Very early treatment in infants became a topic of scientific interest as a result of the case of the 'Mississippi baby'. In 2013 US researchers reported that a child treated from 30 hours after birth was still controlling HIV after more than a year off treatment, perhaps because early treatment had severely limited the number of cells in the child’s body that were infected with HIV – the HIV reservoir.
In most circumstances, the presence of HIV DNA in cells leads eventually to the production of new viruses and a rapid rebound in viral load if antiretroviral treatment is stopped. In the case of the Mississippi baby, viral load suddenly rebounded at the age of three years and nine months after more than two years off treatment.
Since the Mississippi baby case was first reported, several studies have been set up to look at the feasibility of very early treatment initiation in infants, and its effects on the HIV reservoir. Part of the rationale for such studies is to determine how frequently and how successfully early treatment initiation limits the establishment of the reservoir of HIV-infected cells.
Studies have also examined how the reservoir shrinks after treatment initiation. Both questions contribute to a better understanding of the circumstances in which the phenomenon of the Mississippi baby – control of HIV off treatment – might be replicated by a combination of antiretroviral treatment, reduction of the HIV reservoir and some form of immunological or therapeutic vaccine intervention that would help the immune system to control HIV without medication.