HIV-1 Persistence in Children during Suppressive ART

Area of Science:

• Virology
• Immunology
• Pediatrics

Background:

• Perinatally HIV-1-infected children require lifelong antiretroviral therapy (ART).
• Early HIV-1 infection occurs in an immature immune system, influenced by maternal factors.
• Long-term ART in children leads to smaller, less diverse HIV reservoirs compared to adults.

Purpose of the Study:

• To investigate the characteristics of HIV reservoirs in children with perinatal HIV-1 infection on long-term ART.
• To understand the implications of early HIV-1 infection and ART on reservoir persistence and potential cure.

Main Methods:

• Analysis of HIV reservoir size and diversity in perinatally infected children on ART.
• Comparison of proviral landscape in children versus adults.
• Assessment of clonal expansion of HIV-infected cells.

Main Results:

• Children initiating early ART show smaller and less diverse HIV reservoirs than adults.
• Despite viral suppression, the proviral landscape in children on ART resembles that of adults.
• Long-term persistence of early infected cells via clonal expansion is a significant challenge.

Conclusions:

• Early ART initiation in perinatally HIV-1-infected children reduces reservoir size but does not eliminate persistence.
• Clonal expansion of HIV-infected cells presents a major hurdle for achieving an HIV cure.
• Understanding long-term HIV persistence and ART effects is crucial for managing comorbidities and pursuing a cure.