Reducing HIV reservoirs in neonates with very early antiretroviral therapy

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 to break down and highlight her study published in The Lancet HIV that aimed to assess if very early antiretroviral therapy (ART) in neonates could restrict HIV reservoirs.

This is the second installment of a video series with Persaud. Click here to watch the first episode, which provides background and distinguishes very early ART from early ART.

In this episode, Persaud explains the study's 2 cohorts, outcomes, and the on-going status of the trial.

The on-going IMPAACT P1115 study (NCT02140255) included 440 infants at least 34 weeks' gestational age at high risk for in-utero HIV-1, with either untreated maternal HIV-1 or who were receiving "pre-emptive triple antiretroviral prophylaxis outside of the study," (cohort 1 and cohort 2, respectively), Persaud and colleagues wrote.

Of 54 infants who were initiated on very early ART, 10 met all criteria for possible analytical treatment interruption. Part of this criteria was meeting a predetermined biomarker of undetectable RNA since week 48, HIV-1 antibody-negative, HIV-1 DNA not detected, and normal CD4 count and CD4 percentage.

"We were planning analytical treatment interruption around age 2 [years]," Persaud told Contemporary Pediatrics, "but it got delayed because of COVID... This part of the study is on-going to detect if we are able to replicate the case of the Mississippi baby."

"I think what this is telling us, at least for newborns that maintained suppression," continued Persaud, "1 in 5 got to a biomarker profile to assess whether they're in remission."

If you missed the first installment of our video interview with Deborah Persaud, MD, click here to watch it.

Reference:

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