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A newborn immune system responds to HIV infection less effectively than a more mature one, so an HIV-positive baby should be started on antiretroviral therapy as soon after birth as possible, new research suggests. Although treatment early in life was known to be advantageous, the study, published Wednesday in Science Translational Medicine, shows the immune system’s response in detail for the first time. The study could energize efforts to treat newborns with HIV, several experts say, and it may help pave the way for an eventual long-lasting treatment or even a cure. In the study, 10 HIV-positive newborns in Botswana were started on antiretroviral therapy—the gold-standard treatment for HIV—within hours or days of birth instead of the more typical four months. If an HIV-positive pregnant woman is receiving treatment, and the amount of virus in her body is well controlled, she will not pass the disease on to her baby, although the infant will have antibodies to HIV in his or her bloodstream. If the mother’s disease is not well controlled, the baby may be born with HIV.
To look for HIV-positive babies, the team screened more than 10,000 newborns using very small amounts of blood. The researchers identified 40 who were HIV-positive and began treating them with a three-drug cocktail within days of birth. The study reported on 10 of those babies, who are now almost two years old, and compared them with HIV-positive babies who did not receive treatment until four months of age. The early treated babies fared much better in measures of viral levels in their bloodstream and lower levels of immune activity, which predicts the course of the disease, according to the study, which was conducted by a research team at the Ragon Institute of Massachusetts General Hospital, the Massachusetts Institute of Technology and Harvard University, Brigham and Women’s Hospital, and the Botswana Harvard AIDS Institute Partnership in Botswana. The babies coped well with the drug regimen, with only one having to discontinue therapy because of side effects, said Roger Shapiro, a senior author of the paper and an immunologist at the Harvard T. H. Chan School of Public Health, in a news conference on Tuesday.
The stakes are high for getting tScientists have known since a study published in 2008 that treating HIV-positive babies as early as possible leads to better outcomes, but the new paper provides a “very comprehensive scientific rationale for why that is the case,” says Sten Vermund, dean of the Yale School of Public Health and a pediatrician and infectious disease epidemiologist, who was not involved in the new research. “As soon as possible might be too late. We really would be better treating right at birth.”hese babies treated, says Pat Flynn, an infectious disease specialist at St. Jude Children’s Research Hospital in Memphis, Tenn., who was not involved in the new study. HIV infection can have devastating neurological consequences, likely because of ongoing inflammation in the brain. Every day, between 300 and 500 babies in sub-Saharan Africa are infected with HIV, according to the study’s authors, who cite data from the Joint United Nations Program on HIV/AIDS (UNAIDS). Up to half of them will die by age two if they do not receive antiretroviral therapy. Infants infected in utero face even worse outcomes than those infected during birth or breastfeeding, said Mathias Lichterfeld, a co-author and an infectious disease specialist at the Ragon Institute and Brigham and Women’s in the news conference. Putting all HIV-positive pregnant women on antiretroviral therapy is the best way to prevent them passing the virus to their babies, but many such women face barriers to accessing treatment, Shapiro said....
Published in Science Translational Medicine (27 Nov. 2019):
