Immediate treatment with antiretroviral therapy helps infants with HIV
“Our study suggests that strategies to test and treat infants immediately after birth may improve outcomes. We find that ART initiation within hours after birth is doable and translates into multiple benefits for the infants — lower frequencies of reservoir cells and improved immune responses,” said Lichterfeld, the corresponding author and an associate physician in the Division of Infectious Diseases at the Brigham. Lichterfeld is also an associate member of the Ragon Institute of MGH, MIT and Harvard; and an associate nember of the Broad Institute of MIT and Harvard. “What excites me most about this work is that making a comparatively small change in the timing of treatment may have a large impact on long-term treatment outcomes.”
The EIT study is a prospective clinical trial that enrolled infants from two major maternity hospitals in the Francistown and Gaborone regions of Botswana, a country with the third highest HIV-1 prevalence in the world. Infants enrolled in the study began ART in the first days (frequently, within hours) immediately following their births. The team compared their results to those of infants not in the study who received ART later (within a median of four months after birth). Infants were then followed for two years with blood sampling at regular intervals.
Investigators focused on 10 infants enrolled in the EIT study who were HIV positive at birth. They measured the number of virally infected cells (typically called viral reservoir cells) and many different types of innate and adaptive immune responses. The team observed that the number of reservoir cells was extremely small (significantly smaller than in adults who were on ART for a median of 16 years). The number of reservoir cells was also significantly smaller than in infected infants who started treatment later. The team also identified specific types of innate immune cells (NK cells and monocytes) that were on the rise while the viral reservoir size shrank, suggesting that these cells may influence or modulate viral reservoir cells.