Starting infants who contract HIV during pregnancy or delivery on antiretrovirals (ARVs) sooner after birth is associated with a shorter time to their achieving an undetectable viral load, Infectious Disease Advisor reports.
Juliane Schröter, PhD, a professor of theoretical biology and bioinformatics at Utrecht University in Utrecht, The Netherlands, and colleagues analyzed data on 312 infants born between 1997 and 2013 who contracted HIV from their mothers during pregnancy or delivery. They published their findings in the Journal of Acquired Immune Deficiency Syndromes.
Infants who started treatment for HIV within six months after birth were prescribed a standard ARV regimen that included either a boosted protease inhibitor or non-nucleoside reverse transcriptase inhibitor plus two or three nucleoside/nucleotide reverse transcriptase inhibitors.
The infants were put on ARVs at a median age of 82 days. The majority of them achieved a fully suppressed viral load and remained virally suppressed for a median of 132 days.
Infants achieved a fully suppressed viral load faster if they were started on treatment sooner after birth and if they had a lower viral load and a higher CD4 percentage at the time they started ARVs.
The infants whose viral load declined erratically had more changes in their ARV regimens and more interruptions in treatment, suggesting that these infants’ caretakers were not adhering well to the pediatric ARV regimen and the children’s virus was developing drug resistance as a result.
The study was limited by the researchers’ uncertainty about whether the mother-to-child transmission of HIV occurred during pregnancy or delivery. The fact that any infants who contracted the virus in utero had the virus longer than any of those infected during delivery complicates mathematical modeling attempts to compare the effect of the timing of treatment initiation on declining viral load.
“Data presented here support the fact that age at the start of ART is less helpful than markers of infections, such as [viral load] and CD4 percentage, to determine [time to viral suppression],” the study authors concluded. “Early [ARV treatment] initiation combined with a fast viral suppression may lead to a reduction of the early established latent viral reservoir by shortening the viral exposure time. As a next step, the effect of these criteria on sustained [viral load] suppression has to be investigated.”
To read the Infectious Disease Advisor article, click here.
To read the study abstract, click here.