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Very early combination antiretroviral therapy in infants: prospects for cure

Rainwater-Lovett, Kaitlina; Luzuriaga, Katherineb; Persaud, Deboraha

Current Opinion in HIV and AIDS: January 2015 - Volume 10 - Issue 1 - p 4–11
doi: 10.1097/COH.0000000000000127
THE CASE FOR EARLY ANTIRETROVIRAL THERAPY TOWARDS A CURE OF HIV INFECTION: Edited by John W. Mellors and Jintanat Ananworanich
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Purpose of review A single case of sustained HIV control in the absence of antiretroviral therapy or HIV-specific immune responses ensued following 18 months of combination antiretroviral therapy initiated at 30 h of age in a perinatally HIV-infected child (the Mississippi child). This case provides proof-of-concept that delay in HIV viremic rebound may ensue following very early treatment (VET) in perinatal infection, likely through marked reduction of latent replication-competent HIV reservoirs.

Recent findings The latent HIV reservoir remains the critical barrier to remission. Several studies indicate that the earlier effective combination antiretroviral therapy is initiated, the smaller the size of the HIV reservoir. The unique ability of perinatally infected neonates to initiate VET at the time of birth maximizes the potential benefits of limiting latent reservoir size and permitting reservoir decay, likely lengthening the duration of remission and limiting the capacity for re-establishment of viremia.

Summary This article covers the rationale and feasibility of VET to achieve sustained virologic remission in perinatal infection. Recent studies highlighting the effects of VET on biomarkers of HIV persistence in perinatal HIV infection are reviewed as well as implications and challenges for cure research in pediatric populations.

aDepartment of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

bProgram in Molecular Medicine, Department of Pediatrics, and Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Correspondence to Deborah Persaud, Department of Pediatrics, John Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg., Rm. 1170, Baltimore, MD 21287, USA. E-mail: dpers@jhmi.edu

© 2015 Lippincott Williams & Wilkins, Inc.