Some babies appear free of infection
Newborns diagnosed with human immunodeficiency virus and then treated with combination antiretrovirals within 48 hours of birth can achieve undetectable viral loads – so low that testing may show the children as HIV negative, researchers reported here.
Of 30 babies born in one hospital in South Africa, 10 achieved undetectable viral loads within a year of birth, reported Louise Kuhn, PhD, of Columbia University in New York City.
Of those 10 babies, three now show no evidence of infection, even when tested with polymerase chain reaction (PCR) methods, Kuhn reported at the annual Conference on Retroviruses and Opportunistic Infections.
“These babies still have HIV infection,” she told MedPage Today. “They remain on treatment.”
She and colleagues recruited HIV-infected neonates at Rahima Moosa Mother and Child Hospital in Johannesburg.
“We identified these HIV-infected neonates at birth and we attempted to start them on treatment within 48 hours,”
Kuhn said. “We then followed them over time to see their virological response to antiretroviral treatment. About 30% of the babies achieved the lower detection level of RNA, and these levels were sustained.”
The children were initially treated with a combination of nevirapine, zidovudine, and lamivudine and after a median of 27 days on that antiretroviral therapy they were transitioned to a regimen of boosted lopinavir instead of nevirapine.
“We found that three of them became HIV negative on standard PCR assays. A PCR diagnostic assay is intended to identify HIV RNA and HIV DNA and is intended to determine if the presence of virus exists,” she said. “However, we do not adequately know the threshold of detection; we only know that they are not detectable at this level of the standard assay.
“We do not know in these children if the virus has actually gone away so we continue to treat them. We continue to test them and maintain them on treatment. We also intend to do several more detailed studies to better understand what is happening with their response to treatment,” she said.
She said that seven other babies had achieved suppression of virus to undetectable levels using a 20-cells/mm3 assay. Three of the babies died within 3 months of the start of therapy. All were boys. Of the 30 babies included in the report, 17 were girls and 13 were boys. Their mean birth weight was 3,015 grams.
About 30% of the mothers had not been receiving antiretroviral therapy; about 15% of the mothers had received therapy before this pregnancy; about 30% of the women had been on combination therapy for at least 12 weeks before delivery; about 25% of the mothers had received antiretroviral therapy for less than 12 weeks before delivery.
“This was the largest cohort of infants diagnosed at birth and then started rapidly on antiretroviral treatment. They looked at the variability of response with some children having a very good response and others not so good,” Elaine Abrams, MD, also of Columbia University, who moderated a press conference at which the study was discussed, told MedPage Today.
“But most importantly [Kuhn] showed that some children are able to achieve an undetectable viral load and no detectable virus using routine assays,” said Abrams, who was one of several co-authors in the study. “It demonstrates that these early treated infants are an excellent platform to study HIV latency, reservoirs and potentially remission.”
David W. Rosenthal, DO, PhD, medical director of the Center for Young Adult, Adolescent and Pediatric HIV, Northwell Health, Great Neck, N.Y ., said that international studies testing early treatment of newborns who can be rapidly identified with HIV infection are underway.
“This type of treatment is feasible and can be effective in controlling viral loads even in newborns,” he told MedPage Today.
He said that early treatment in resource-limited settings can be complicated by inability to determine if the child is infected at birth, due to delays in getting blood samples analyzed.
In the United States, Rosenthal said, the number of children born with HIV is vanishingly small, but it still occurs — mainly among women who fail to have prenatal treatment. “We still need to work on preventive services so this vertical infection does not occur,” he said.
Source: MedPage Today