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Early therapy in HIV-1-infected children: effect on HIV-1 dynamics and HIV-1-specific immune response

Marisa Zanchetta1, Alessia Anselmi, Daniela Vendrame

  • 1AIDS Reference Center, Unit of Viral Oncology, Department of Oncology and Surgical Sciences, University of Padova, IOV-IRCCS, Italy.

Antiviral Therapy
|April 9, 2008
PubMed

Insights

Early antiretroviral therapy (ART) in infants controls human immunodeficiency virus type 1 (HIV-1) replication but does not eliminate the virus. Infants on ART show reduced viral loads, though latent reservoirs persist, preventing complete eradication.

Area of Science:

  • Pediatric Infectious Diseases
  • Immunology
  • Virology

Background:

  • Perinatal HIV-1 infection occurs during immune system development, leading to uncontrolled viral replication.
  • Limited data exist on viral dynamics and immune responses in infants receiving early, aggressive antiretroviral therapy (ART).

Purpose of the Study:

  • To investigate viral dynamics and immunological responses in infants with HIV-1 infection who initiated ART shortly after birth.

Main Methods:

  • Studied six infants with HIV-1 who started ART within three months of age, with a median follow-up of 61 months.
  • Assessed plasma HIV-1 RNA, cell-associated HIV-1 DNA, HIV-1 mRNAs, HIV-1 antibodies, and CD4+/CD8+ T-cell subsets.
  • Measured HIV-1 cellular immune response using EliSpot assay.

Main Results:

  • All infants achieved undetectable plasma viremia; HIV-1 DNA persisted in four, with detectable mRNA in two.
  • Two infants remained seronegative for HIV-1 antibodies after losing maternal antibodies; no cellular immune response was observed.
  • Upon therapy interruption, the HIV-1-seronegative infant experienced more rapid and higher viral rebound than the HIV-1-seropositive infant.

Conclusions:

  • Early ART in infants controls HIV-1 replication and viral load below immune response thresholds.
  • However, early ART does not prevent the establishment of latent HIV-1 reservoirs, precluding virus eradication.
  • Infants on early ART may maintain lower viral loads but do not achieve a functional cure.
Abstract

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