Study: For ba­bies born with HIV, start treat­ment right away

Times-Herald (Vallejo) - - NEWS - By Lau­ran Neer­gaard

WASH­ING­TON >> When ba­bies are born with HIV, start­ing treat­ment within hours to days is bet­ter than wait­ing even the few weeks to months that’s the norm in many coun­tries, re­searchers re­ported Wed­nes­day.

The find­ings, from a small but unique study in Botswana, could in­flu­ence care in Africa and other re­gions hit hard by the virus. They also might of­fer a clue in sci­en­tists’ quest for a cure.

The Har­vard-led team found su­per early treat­ment lim­its how HIV takes root in a new­born’s body, shrink­ing the “reser­voir” of virus that hides out, ready to re­bound if those young­sters ever stop their med­i­ca­tions.

“We don’t think the cur­rent in­ter­ven­tion is it­self cu­ra­tive, but it sets the stage” for fu­ture at­tempts, said Dr. Daniel Ku­ritzkes of Bos­ton’s Brigham and Women’s Hos­pi­tal, who coau­thored the study.

Giv­ing preg­nant women a cock­tail of anti-HIV drugs can pre­vent them from spread­ing the virus to their un­born chil­dren, a step that has dra­mat­i­cally re­duced the num­ber of ba­bies born with the virus world­wide. Still, some 300 to 500 in­fants are es­ti­mated to be in­fected ev­ery day in sub-Sa­ha­ran Africa.

Doc­tors have long known that treat­ing ba­bies in the first weeks to months of life is im­por­tant, be­cause their de­vel­op­ing im­mune sys­tems are es­pe­cially vul­ner­a­ble to HIV. But an in­fant dubbed the “Mis­sis­sippi baby” raised a crit­i­cal ques­tion: Should treat­ment start even ear­lier? The girl re­ceived a three-drug com­bi­na­tion within 30 hours of her birth in July 2010, highly unusual for the time. Her fam­ily quit treat­ment when she was a tod­dler — yet her HIV re­mained in re­mis­sion for a re­mark­able 27 months be­fore she re­lapsed and restarted ther­apy.

The Botswana study was one of sev­eral funded by the U.S. Na­tional In­sti­tutes of Health af­ter doc­tors learned of the Mis­sis­sippi

baby, to fur­ther ex­plore very early treat­ment.

The find­ings are en­cour­ag­ing, said Dr. Deb­o­rah Per­saud, a pe­di­atric HIV spe­cial­ist at Johns Hop­kins Univer­sity who wasn’t in­volved with the Botswana study but helped eval­u­ate the Mis­sis­sippi baby.

“The study showed what we hy­poth­e­sized hap­pened in the Mis­sis­sippi baby, that very early treat­ment re­ally pre­vents es­tab­lish­ment of these long-lived reser­voir cells that cur­rently are the bar­rier to HIV erad­i­ca­tion,” Per­saud said.

She cau­tioned: “Very early treat­ment is im­por­tant, but pre­ven­tion should still be our top pri­or­ity.”

In Botswana, re­searchers tested at-risk new­borns, en­rolling 40 born with HIV, treat­ing them within hours to a few days, and track­ing them for two years. On Wed­nes­day, they re­ported re­sults from the first 10 pa­tients, com­par­ing them with 10 in­fants get­ting reg­u­lar care — treat­ment be­gin­ning when they were a few months old.

Med­i­ca­tion brought HIV un­der con­trol in both groups. But the chil­dren treated ear­li­est had a much smaller reser­voir of HIV in their blood, start­ing about six months into treat­ment, the re­searchers re­ported in Science Trans­la­tional Medicine.

The ear­li­est-treated chil­dren also got another ben­e­fit: more nor­mal func­tion­ing of some key parts of the im­mune sys­tem.

One big ques­tion: Did the HIV reser­voir shrink enough to make a longterm dif­fer­ence? To find out, next year the re­searchers will give these chil­dren ex­per­i­men­tal an­ti­bod­ies de­signed to help keep HIV in check, and test how they fare with a tem­po­rary stop to their anti-HIV drugs.

In the U.S., Europe and South Africa, it’s be­com­ing com­mon to test at-risk in­fants at birth. But in most lower-in­come coun­tries, ba­bies aren’t tested un­til they’re 4 to 6 weeks old, said study co-au­thor Dr. Roger Shapiro, a Har­vard in­fec­tious dis­ease spe­cial­ist.

CYNTHIA GOLDSMITH — CEN­TERS FOR DIS­EASE CON­TROL AND PRE­VEN­TION

This un­dated photo shows a scan­ning elec­tron mi­cro­graph of mul­ti­ple round bumps of the HIV-1 virus on a cell sur­face.

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