Landmark study: More babies born with HIV could live beyond their first birthday

HIV is one of the greatest medical scourges of our world. The virus progresses slowly over time, destroying the immune system as it goes. Eventually it becomes AIDS. HIV/AIDS has killed 32 million people since the AIDS epidemic began in 1981. It is not discriminatory — anyone can get HIV.

One of HIV’s most devastating traits is how it can be passed on from person to person — including from mother to child. The virus can be transmitted in the womb, during birth, or during breast feeding. In the United States alone, as many as 7,000 women with HIV will give birth each year, the American Pregnancy Association says. If they don’t seek treatment for the virus, some 25 percent of them will pass it on to their babies. That puts their lives at risk as soon as they are born.

If HIV is left untreated, some 30 percent of HIV-positive infants die by their first birthday, and 50 percent die by their second, estimates suggest.

But there is hope on the horizon — and it comes in the form of drugs we already have to tackle the virus. But when it comes to treating infants with HIV effectively, timing may be the key.

The earlier, the better

In a landmark study, scientists show that certain anti-HIV medicines can be used from birth to attack the virus’ stronghold in the immune system — buying the child’s body crucial time to start fighting back.

Treating infants in the hours after they are born is not standard practice in the US. But the study suggests those few hours may make all the difference.

The US Department of Health and Human Services advises that infants get tested for HIV as early as possible in life. “Rapid” treatment is generally considered to be between one to two weeks of birth. In a ptrials have tested a treatment for HIV positive infants that can be administered as soon as the second day of life.

Roger Shapiro, study author and associate professor at Harvard University, said in a press conference that early intervention like this doesn’t always happen. Scientists should be thinking more on the timescale of hours and days, rather than weeks, he said.

“There’s been data from clinical trials suggesting that kids do better when they’re started within weeks or months of life, but there really haven’t been good study to look at whether what happens when we start within days of life until this study,” he said.

The study was published this week in the journal Science Translational Medicine.

Targeting HIV’s stronghold

Part of what makes this research stand out is where it took place. In the United States, the rate of perinatal HIV is extremely low, but in sub-saharan Africa, between 300 and 500 children are infected with HIV every day, Shapiro said.

In this study, Shapiro and a team of researchers in Botswana followed 40 children born to women with HIV to track how their health developed over time. This study reports on 10 of the children, who received anti-HIV medicines including Nevirapine seven hours after they were born.

Getting these drugs at birth severely depleted the reservoir of HIV positive cells in the body — cells that would have lay in wait and gone on to attack the immune system throughout the child’s life. In fact, these infants’ reservoirs were smaller than those adults who had been on anti-HIV drugs for 16 years.

The infants’ immune systems also coped better with the HIV virus that was already active in their cells. Taken together, the findings suggest that getting the drug treatment at birth could significantly extend these infants’ life expectancy.

This is not a surprise: Early intervention is considered the gold standard for treating HIV positive infants. One famous case that speaks to that is that of a child born in 2010 with HIV. Known as the “Mississippi baby,” the baby girl received HIV treatment within 30 hours of bring born. As a result of this early dose, she seemed to be cured of HIV. She continued to receive treatment for 18 months — once it stopped, the virus appeared to have retreated entirely.

But not all such early interventions have worked. In 2014, the virus resurfaced in a child who had received a similar treatment to the Mississippi baby — 27 months after the treatment ended.

Taken together, it may be that the drug used and the timing factor in to children’s long-term health outcomes, but more work is needed to determine the role different elements play.

While not offering a cure for HIV, the new study hints at how crucial early treatment with antiretroviral drugs can be. In this case, the earlier, the better.

Abstract:

Neonatal HIV-1 infection is associated with rapidly progressive and frequently fatal immune deficiency if left untreated. Immediate institution of antiretroviral therapy (ART), ideally within hours after birth, may restrict irreversible damage to the developing neonatal immune system and possibly provide opportunities for facilitating drug-free viral control during subsequent treatment interruptions. However, the virological and immunological effects of ART initiation within hours after delivery have not been systematically investigated. We examined a unique cohort of neonates with HIV-1 infection from Botswana who started ART shortly after birth and were followed longitudinally for about 2 years in comparison to control infants started on treatment during the first year after birth. We demonstrate multiple clear benefits of rapid antiretroviral initiation, including an extremely small reservoir of intact proviral sequences, a reduction in abnormal T cell immune activation, a more poly- functional HIV-1–specific T cell response, and an innate immune profile that displays distinct features of improved antiviral activity and is associated with intact proviral reservoir size. Together, these data offer rare insight into the evolutionary dynamics of viral reservoir establishment in neonates and provide strong empirical evidence supporting the immediate initiation of ART for neonates with HIV-1 infection.