Providing background on very early neonatal antiretroviral therapy to restrict HIV reservoirs

For infants born with HIV-1, lifelong antiretroviral therapy (ART) therapy is currently required. Authors of a recent study published in The Lancet HIV aimed to assess if very early ART in neonates could restrict HIV-1 reservoirs.¹

Lead investigator Deborah Persaud, MD, director, Eudowood Division of Pediatric Infectious Diseases, Johns Hopkins Children’s Center; professor of pediatrics, Johns Hopkins University School of Medicine, joined Contemporary Pediatrics in this video interview to discuss the study and explain the differences between very early ART and early ART, and why that difference is so crucial related to the goal of ART-free remission.¹

"Very early treatment is actually very different from early treatment of pediatric HIV infection," Persaud explained. "Early treatment is when you can start the combination of ART drugs around 2 to 3 months of age... What we're talking about here is very early treatment or treatment within the first 48 hours of life."

The start of the phase 1/2 proof-of-concept study has been in the making for a long time, starting with the case of the Mississippi baby.¹

"Almost every person who is infected with HIV has to take the combination of ART for life," Persaud said. "What we identified in the Mississippi baby in 2013 was this infant who was infected and started on ART drugs, but the treatment was started at 30 hours [of life]... This infant went off therapy at 18 months of age and the virus did not bounce back. When we first evaluated her, she was 5 months off of treatment and the virus had not come back."

Watch the entire video above for further explanation of the study, background on the Mississippi baby, and recognition of HIV infection in pregnant people.¹

This is the first segment of a video interview series with Deborah Persaud, MD. Click here to watch the second episode.

Reference

1. Persaud D, Bryson Y, Nelson B, et al. HIV-1 reservoir size after neonatal antiretroviral therapy and the potential to evaluate antiretroviral-therapy-free remission (IMPAACT P1115): a phase 1/2 proof-of-concept study. The Lancet HIV. doi::0.1016/S2352-3018(23)00236-9