Very early combination antiretroviral therapy in infants: Prospects for cure

Kaitlin Rainwater-Lovett, Katherine Luzuriaga, Deborah Persaud

Research output: Contribution to journalReview article

Abstract

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 30h 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.

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.

Original languageEnglish (US)
Pages (from-to)4-11
Number of pages8
JournalCurrent opinion in HIV and AIDS
Volume10
Issue number1
DOIs
StatePublished - Jan 12 2015

Keywords

  • HIV cure
  • HIV remission
  • Latent reservoir
  • Perinatal HIV

ASJC Scopus subject areas

  • Immunology
  • Hematology
  • Oncology
  • Oncology(nursing)
  • Infectious Diseases
  • Virology

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