Early antiretroviral treatment reduces viral reservoirs in HIV-infected teens

March 04, 2013

A study led by University of Massachusetts Medical School professor and immunologist Katherine Luzuriaga, MD, and Johns Hopkins Children's Center virologist Deborah Persaud, MD, highlights the long-term benefits of early antiretroviral therapy (ART) initiated in infants.

The study, presented on March 4 at the 20th annual Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta, shows that ART administered in early infancy can help curtail the formation of hard-to-treat viral sanctuaries -- reservoirs of "sleeper" cells responsible for reigniting infection in most HIV patients within weeks of stopping therapy.

The report describes nine teenagers, five of whom started ART around two months of age. Ultrasensitive testing showed dramatically lower copy numbers of viral DNA in the five teens who received ART within two months of exposure compared to the four teens who started treatment at a later age. In addition, serial testing demonstrated a small decay in the amounts of HIV DNA in the blood of the early-treated children over time. Moreover, using very sensitive techniques, the researchers were not able to recover HIV from the early-treated teens. In contrast, clinical tests detected viral hideouts in the late-treated teens. Four of the five early-treated children showed no HIV-specific antibodies on standard testing, but antibodies were detected in the blood of all four who started treatment late.

In a related report, Dr. Luzuriaga and Dr. Persaud reported on March 3 the case of an infant who underwent remission of HIV infection after receiving ART within 30 hours of birth. Altogether, these findings, the researchers say, can help pave the way toward achieving long-term viral suppression without treatment in children. Long-term viral suppression without treatment is an exceedingly rare phenomenon observed in so-called "elite controllers," HIV-infected patients whose immune systems are able to rein in viral replication and keep the virus at clinically undetectable levels even without treatment. HIV experts have long sought a way to help all HIV patients achieve such elite-controller status.

"Preventing mother-to-child transmission remains our primary goal but these studies provide the impetus for further studies aimed at curing children if they do acquire infection," says Luzuriaga.

Luzuriaga, a professor of pediatrics and molecular medicine at UMass Medical School, has been investigating maternal-fetal transmission and pediatric HIV since the disease was first identified. Her laboratory focuses on the immunopathogenesis of persistent viral infections in humans, and the development of prophylactic and therapeutic vaccine strategies for HIV.
-end-
Her recent paper in the Journal of Virology (Identification of ongoing human immunodeficiency virus type 1 (HIV-1) replication in residual viremia during recombinant HIV-1 poxvirus immunizations in patients with clinically undetectable viral loads on durable suppressive highly active antiretroviral therapy. J Virol. 2009 Oct; 83(19):9731-42.), is an example of her laboratory's work in understanding the persistence of HIV infection.

Her 2004 New England Journal of Medicine report (A trial of three antiretroviral regimens in HIV-1-infected children. N Engl J Med. 2004 Jun 10; 350(24):2471-80.) indicated that at an age of three months or younger, initiation of therapy and treatment with stavudine, lamivudine, nevirapine, and nelfinavir were associated with improved long-term viral suppression.

The research was funded by the National Institutes of Health and by the American Foundation for AIDS Research (amfAR).

Related:

International Maternal Pediatric Adolescent AIDS Trials Network https://www.nichd.nih.gov/research/supported/Pages/impaact.aspx

CROI http://retroconference.org/2013/general-information

University of Massachusetts Medical School

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.