There are nearly 500 babies born in sub-Saharan Africa who have HIV upon birth. In many of these countries, the standard treatment of an HIV positive baby is to start them on medications within weeks or months after their birth.
However, the concern is that these children cannot handle the powerful drugs.
For years, researchers felt that treating newborns immediately was the best idea. According to Johns Hopkins Children’s Center virologist Deborah Persaud, a Mississippi baby was treated within 30 hours of her birth. She went off the drugs when she was 18 months old and didn’t see a resurgence of the disease until she was four.
Doctors were under the assumption that her two years of being drug-free meant it was imperative to get treatment early. And, since that time, it became standard to treat U.S. babies at risk for HIV with drugs immediately after birth.
Some doctors, on the other hand, feel additional clinical evidence is necessary to ensure the treatments are safe and more effective than actually delaying the treatment.
The results of a Botswana clinical trial is supporting this theory. The researchers looked at 10 HIV-positive babies who began a drinkable three-drug cocktail of antiretrovirals within days of their birth. After two years of taking these drugs, the virus is nearly undetectable in their blood compared to those who waited months after their delivery to begin antiretrovirals (they had 200 times more HIV in their bodies).
Daniel Kuritzkes, a co-author of the study, said treating kids early doesn’t mean a cure, but does increase the chance for long-term HIV remission.
Kuritzkes, who is Brigham’s Division of Infectious Disease chief, said there might be two reasons for this:
With early intervention, the immune system is better protected from HIV damage.
He said the study is further evidence that early treatment is both effective and safe for babies.
Persaud wasn’t involved with the Botswana study but said when HIV infects a person, it embeds itself in cells that allow it to remain hidden for years. No HIV medication can rid the virus out of the reservoirs right now. However, with early treatment, the virus is unable to replicate since a newborn’s immune system is still developing, as it has a minute amount of hidden HIV in the body.
There are currently three current large-scale clinical trials involving early treatments in babies – Bostwana, a second South Africa study and the P1115 study, which has numerous sites throughout the world – Thailand, India and Brazil, to name a few.
The goal is to help HIV positive people forget that they have it and not take drugs daily for it without the fear of infecting other people or deal with side effects.
Kuritzkes said the next phase of the Botswana trial is to use an experimental treatment that involves the body’s broadly neutralizing antibodies – a method used in adults but not in children just yet.
For now, it appears that treating HIV early on is promising, but still, the problem becomes how to get these drugs to those children who need them.
Kuritzkes said infrastructure like the ones in the U.S. and Botswana is necessary to find those children and get them immediate help. Botswana officials, realizing they had a high HIV rate, came up with a treatment plan to ensure free access to the HIV drugs for people who needed them.
Study researchers agree that keeping kids from getting HIV is the most important thing, but for the ones that fall through the cracks, it’s imperative they start treatment as early as possible to live a healthy life.
Written by Mark Riegel, MD
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