• Posted December 11, 2023

Swift Use of Antiretrovirals in Infected Newborns Can Banish HIV

When an HIV-infected child known as the 'Mississippi baby' was given powerful antiretroviral drugs within hours of birth in 2013 and then appeared to be rid of HIV, people wondered if it might be replicated in other newborns.

An international study involving 54 babies suggests it can.

Researchers now believe that if HIV-infected newborns receive antiretroviral therapy (ART) within two days of birth, rather than weeks or months, it could push the virus to undetectable levels in their blood going forward.

"We sought proof of the concept that if you can safely treat babies with a three-drug regimen within 48 hours of life, you can limit the buildup of these [HIV] reservoirs and get them to very low levels that may lead to ART-free remission, where the virus doesn't come back quickly if the ART is stopped in later phases of the trial,"explained study lead author Dr. Deborah Persaud. She's a physician-scientist and researcher at the Johns Hopkins Children's Center in Baltimore.

The new study was funded by the National Institutes of Health and published recently in The Lancet HIV medical journal.

Infected mothers can pass on HIV, the virus that causes AIDS, to their children at birth. While there's no cure for HIV, antiretrovirals can suppress the virus so that it doesn't progress to AIDS.

HIV-positive infants have typically been given ART within weeks of birth. However, the Mississippi baby's example suggested that employing ART sooner might be better.

Persaud was involved in studying the Mississippi case, in which an infant treated very early with antiretrovirals remained free of active HIV for 27 months after stopping ART.

Giving a newborn the therapy within 48 hours of birth appears to prevent HIV from forming hidden "reservoirs" within the body that remain unreachable by medications.

In the new study, Persaud's group tracked outcomes for 54 babies born with HIV in Africa, Asia, North America and South America. The babies were born between early 2015 and late 2017.

One group ("group 1") of 34 newborns received a three-drug ART cocktail --azidothymidine (AZT) or abacavir, lamivudine (3TC) and nevirapine -- within 48 hours of birth. The babies' mothers had not received antiretroviral meds during their pregnancy.

Another group ("group 2") of 20 newborns got the same trio of meds with the same timing, but with a slightly lower dose of nevirapine. In this group, all mothers had gotten ART while pregnant.

Infants also got a fourth medicine, lopinavir-ritonavir, if they happened to remain HIV-positive after being about 14 days old, an age thought to be safe for using that drug, Persaud's group explained.

"Overall, these four drugs are not the most potent ART regimen, but they were the only drugs approved for the prevention of HIV in newborns and treatment of infants at the time of the study,"Persaud noted in a Hopkins news release.

By 2 years of age, "83% in group 1 and 100% in group 2 tested negative for HIV antibodies, and 64% in group 1 and 71% in group 2 had no detectable HIV DNA" in blood samples, according to the study.

These results seem to confirm that early delivery is crucial with regard to ART's benefits for HIV-infected newborns.

"If you treat at 2 to 3 months of age, when most children start a regimen, very, very, very few kids would actually get to this undetectable stage by 2 years of age,"explained Persaud, who also directs the Eudowood Division of Pediatric Infectious Diseases at the Children's Center.

"It would actually take them until 5 years of age and older to get to a low HIV DNA level, and it's never to this undetectable level," she noted.

More information

There's more on HIV and newborns at Boston Children's Hospital.

SOURCE: Johns Hopkins University, news release, Dec. 7, 2023