Immediate treatment with antiretroviral therapy helps infants with HIV

November 27, 2019

Boston, MA -- HIV infection among infants remains an enormous global health challenge. Each day, 300 to 500 infants in sub-Saharan Africa become infected with the virus. HIV progresses much faster in infants than in adults because of their weaker immune systems. While antiretroviral drugs are highly effective at suppressing HIV in newborns and infants, these drugs are typically not administered immediately after birth, at least not in most countries hardest hit by the HIV epidemic. In 2010, an infant with HIV born in Mississippi was given antiretroviral therapy (ART) within 30 hours of her birth. This infant was then able to maintain spontaneous viral control for several months after stopping antiretroviral therapy, raising the possibility that early treatment might make a critical difference for newborns. The Early Infant Treatment (EIT) Study, led by Roger Shapiro, MD, MPH, from the Harvard T.H. Chan School of Public Health and Mathias Lichterfeld, MD, PhD, and Daniel Kuritzkes, MD, both from Brigham and Women's Hospital, sought to further investigate this possibility in newborns from Botswana. As part of an international collaborative effort, investigators from the Brigham conducted immunological and virological testing, finding that initiating ART immediately, rather than waiting a few weeks, provided measurable benefits for infants born with HIV. The team's results are published in Science Translational Medicine.

"Our study suggests that strategies to test and treat infants immediately after birth may improve outcomes. We find that ART initiation within hours after birth is doable and translates into multiple benefits for the infants -- lower frequencies of reservoir cells and improved immune responses," said Lichterfeld, the corresponding author and an associate physician in the Division of Infectious Diseases at the Brigham. Lichterfeld is also an associate member of the Ragon Institute of MGH, MIT and Harvard; and an associate nember of the Broad Institute of MIT and Harvard. "What excites me most about this work is that making a comparatively small change in the timing of treatment may have a large impact on long-term treatment outcomes."

The EIT study is a prospective clinical trial that enrolled infants from two major maternity hospitals in the Francistown and Gaborone regions of Botswana, a country with the third highest HIV-1 prevalence in the world. Infants enrolled in the study began ART in the first days (frequently, within hours) immediately following their births. The team compared their results to those of infants not in the study who received ART later (within a median of four months after birth). Infants were then followed for two years with blood sampling at regular intervals.

Investigators focused on 10 infants enrolled in the EIT study who were HIV positive at birth. They measured the number of virally infected cells (typically called viral reservoir cells) and many different types of innate and adaptive immune responses. The team observed that the number of reservoir cells was extremely small (significantly smaller than in adults who were on ART for a median of 16 years). The number of reservoir cells was also significantly smaller than in infected infants who started treatment later. The team also identified specific types of innate immune cells (NK cells and monocytes) that were on the rise while the viral reservoir size shrank, suggesting that these cells may influence or modulate viral reservoir cells.
-end-
The authors note that the current study is quite small, entailing the analysis of just 10 EIT infants. A total of 40 infants have been recruited into the study, and samples from the remaining infants are now being analyzed. In addition, a new clinical trial has been started with some of the EIT infants in which a different treatment (broadly-neutralizing antibodies) is being evaluated.

This project was supported by the National Institutes of Health (U01 AI114235, AI120850, AI098487, AI106468, AI117841, AI120008, AI124776, AI130005, AI122377, AI135940, AI116228, AI078799, HL134539, AI125109, and DA047034. Lichterfeld has received speaking and consulting honoraria from Merck and Gilead. A co-author has received consulting honoraria and/or research support from Gilead, Merck, and ViiV.

Brigham and Women's Hospital

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.