Early HIV treatment matters for infants – even within their first 6 months
Every month counts for perinatally HIV-infected infants, as new study reveals the earlier infants begin antiretroviral treatment, the faster they will become virally suppressed.
Infants living with HIV should start antiretroviral treatment (ART) as soon as feasibly possible, with time to viral suppression a factor even within the narrow first six months from birth.
We already know that starting treatment within the first 12 weeks of life dramatically reduces mortality and morbidity in HIV-infected infants. More generally, other studies have demonstrated that early ART can control viral replication and limit the establishment of viral reservoirs, which contribute to long term viral suppression. Cases such as the ‘Mississippi Baby’ also reveal that early, aggressive ART can result in short-term HIV remission in children.
This study published in AIDS journal is the largest and the first study to look at the predictors of viral suppression in perinatally infected infants who started ART within their first six months. The results reveal a significant independent association between fast viral suppression, and age, CD4 cell count, and viral load at ART initiation.
Out of an initial 3,953 children participating in the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) from 17 countries in Europe and Thailand, only 420 infants met the selection criteria: having been perinatally infected (that is, HIV-infected in pregnancy or delivery and not via breastfeeding), under six months at ART initiation, with at least two viral load measurements: one at ART initiation and a second within the following 15 months.
An estimated 89% of the infants achieved viral load suppression at 12 months. At ART initiation, median age was 2.9 months, median percentage CD4 count was 34, and median viral load was 5.5 log10copies/ml.
Other predictors of viral suppression evaluated included gender, ethnicity, initial ART regimen [boosted protease inhibitor or NNRTI plus two or more NRTI] as well as maternal antiretroviral regimen used for prevention of mother-to-child transmission (PMTCT) in the prenatal and delivery period.
Infants who received an antiretroviral prophylaxis regimen within 4 weeks of birth also reached viral suppression faster. Other factors included whether infants were born in the same country in which they were enrolled for HIV care, year of birth, year of ART initiation, and geographical region.
The study showed that relatively small differences in the time of ART initiation among infants initiating therapy within six months of life, could impact the speed of virological suppression, with each additional month before infant initiates ART increasing the time to viral load suppression.
The authors concluded that “these results provide additional support for earlier ART initiation in infants with perinatal HIV and indicate that early treatment influences key virological and immunological parameters that could have important consequences for long term health”