Research on very early ART in neonates at risk of HIV infection.


Shah SK, Persaud D, Wendler DS, Taylor HA, Gay H, Kruger M, Grady C.

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Lancet Infectious Diseases

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The news that the Mississippi child previously in sustained viral remission now has detectable HIV1 is profoundly disappointing. We write to clarify that research on the use of very early antiretroviral therapy (ART) in infants born to mothers with HIV is still important. This development, however, gives reason to think carefully about how to do this research.

Although the Mississippi case did not show how to cure HIV, it is the first documented case in which an infant infected with HIV remained free of detectable HIV for a sustained period, despite not being on ART and not being an elite controller.2 Independent evidence—including animal data,3 evidence from adult cohorts initiating ART in acute infection,4 and data on post-exposure prophylaxis in adults5—suggests that very early combination ART (whether alone or in conjunction with other interventions) might enable infants to avoid a lifetime of ART. Nevertheless, why the Mississippi child had viral remission for more than 2 years, why the virus re-emerged, or whether modifications of this strategy could lead to longer periods of remission (which would enable avoidance of ART and its associated side effects) is not certain.

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