Early Antiretroviral Therapy May Not Achieve HIV Remission in Infants

Starting antiretroviral therapy (ART) for HIV-infected infants within hours of birth does not seem to result in a higher proportion of infants who attain and sustain viral suppression on ART, according to a study published online January in EClinicalMedicine.

Louise Kuhn, Ph.D., from the Columbia University Irving Medical Center in New York City, and colleagues examined whether HIV-infected neonates who initiated ART <14 days after birth and were maintained on ART would be able to maintain viral suppression when ART was withdrawn. Seventy-three HIV-infected neonates were initiated on ART <14 days after birth and were maintained on ART.

Overall, three HIV-infected infants died and nine were lost to follow-up before age 48 weeks. The researchers found that 52.5 percent of those surviving the study attained and sustained viral load <50 copies/mL and half of these sustained CD4+ T cell percentage >30 percent, which were the eligibility criteria for an analytic treatment interruption trial. For the 46 infants starting ART <48 hours after birth and 27 infants starting at two to 14 days after birth, the differences in the proportions with achieved and sustained viral load <50 copies/mL (51.4 and 53.9 percent, respectively) and sustained CD4+ T cell percentage >30 percent (45.7 and 38.5 percent, respectively) were not significantly different.

"The results of our trial suggest that very early treatment in newborns may not have to mean within hours of birth," Kuhn said in a statement. "Starting ART within the first two weeks of life led to similar outcomes to starting within the first two days of life."

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