Earlier ART Improves Outcomes for Newborns With HIV

More than 4 million children have acquired HIV via vertical transmission. In sub-Saharan Africa, 300 to 500 infants acquire HIV daily, which constitutes the majority of perinatal HIV infection globally. HIV progresses faster in the infant population due to their weakened immune system, making early intervention critical.

In many countries where the HIV crisis is severe, it may take several weeks for newborns to be put on ART. The Early Infant Treatment Study examined newborns in Botswana who were immediately put on an ART regimen. Botswana has the third highest HIV-1 prevalence in the world.

Authors of recent study, published in Science Translational Medicine, investigated whether early treatment makes a difference in newborns who have acquired HIV in Botswana. The investigators found that initiating antiretroviral therapy (ART) immediately provides measurable benefits for infants.

The study enrolled infants from 2 maternity hospitals in the Gaborone and Francistown regions of Botswana. The infants began ART within the first days—and frequently within the first hours—following their births. The study team compared the enrolled infants’ results to infants who did not receive ART immediately, with a median initiation of 4 months after birth.

Infants in the Early Infant Treatment Study were then followed for 2 years, with blood sampling to monitor results. The report in Science Translational Medicine includes data from 10 infants enrolled in the study who were HIV positive at birth, measuring their viral reservoir cells as well as other innate and adaptive immune responses.

The study team found that among the 10 infants, reservoir cell counts were small, with significantly smaller counts than adults who were on ART for an extended period. The study team also found that the number of reservoir cells was smaller than in infants who initiated ART later.

Investigators also found that natural killer cells and monocytes rose as viral reservoir size shrank, indicating an improved immune response.

"Our study suggests that strategies to test and treat infants immediately after birth may improve outcomes. We found 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," Mathias Lichterfeld, MD, PhD, corresponding author of the research and an associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital, said in a press release.

Lichterfeld expressed optimism about the differences made by a relatively small difference in treatment initiation time.

"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."