Early antiretroviral therapy increases immune response in infants with HIV

NEW YORK (Reuters Health) - Babies with perinatal infection have HIV should start antiretroviral therapy (ART) before 3 months of age indicate European researchers.Children who participated in the study and received a combination of ARV therapy for at least three drugs in the first three months of life had higher CD4 counts and lower viral load per year of age compared with infants with delayed treatment, reported experts."It is true that the long-term outcome is similar in both groups. But in the beginning of life, no predictors of rapid evolution or not long-term progress. That is why it is better to start treatment all children, "he told Reuters Health, Dr. Tessa Goetghebuer, CHU St. Pierre, Brussels, Belgium."Since the early start of treatment in infants vertically infected with HIV (through mother) is currently recommended in all guidelines, additional efforts to establish the diagnosis of infection as soon as possible after delivery," added the team in Clinical Infectious Diseases.Their study used data from a group of 139 infants with perinatally acquired HIV infection (but not full development of acquired immunodeficiency syndrome OSID) that ARV therapy started before one year of life, including 96 who started treatment before three months .The percentages of CD4 and viral load were starting similar between groups. Viral loads and CD4 levels were measured before treatment and at six, 12, 18, 24 and 48 months of children.Compared to the delayed treatment group, the previously treated cohort showed a slower decline in the percentages of CD4, a lower peak viral load and a shorter time to viral suppression during the first year of life, the authors report.At six months, in groups with early or delayed therapy, respectively, the percentages of CD4 were 43 and 34 percent, versus 2.3 viral load 4.6 copies per milliliter and the percentage of suppression 63 viral and 19 percent.By age, there was a trend to lower viral load in previously ARV-treated group, but none of the differences between the virological and immunological groups was statistically significant.The researchers believe that their sample would have been too small to show effects beyond the year."However, it is possible that the functional competence of CD4 cells to be influenced by the early initiation of therapy and maintained an impact on clinical outcome after 12 months of age," he said."The sooner treatment begins, the better virological control," conclude the authors, who added: "This observation is important because the peak viral load would be correlated with the establishment of a reserve of latent infected cells."