Open AccessEarly Initiation of Antiretroviral Therapy Following In Utero HIV Infection Is Associated With Low Viral Reservoirs but Other Factors Determine Viral Rebound
Author(s) -
Jane Millar,
Nomonde Bengu,
Vinícius Vieira,
Emily Adland,
Julia Roider,
Maximilian Muenchhoff,
Rowena Fillis,
Ken Sprenger,
Vuyokazi Ntlantsana,
Isabella Fatti,
Moherndran Archary,
Andreas Groll,
Nasreen Ismail,
Maria C. Garcia-Guerrero,
Philippa Matthews,
Thumbi Ndung’u,
María C. Puertas,
Javier Martínez-Picado,
Philip Goulder
Publication year - 2021
Publication title -
the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.69
H-Index - 252
eISSN - 1537-6613
pISSN - 0022-1899
DOI - 10.1093/infdis/jiab223
Subject(s) - cart , viremia , viral load , in utero , medicine , immunology , peripheral blood mononuclear cell , transmission (telecommunications) , physiology , virology , human immunodeficiency virus (hiv) , pregnancy , biology , fetus , in vitro , mechanical engineering , biochemistry , electrical engineering , engineering , genetics
Background Early HIV diagnosis allows combination antiretroviral therapy (cART) initiation in the first days of life following in utero (IU) infection. The impact of early cART initiation on infant viral reservoir size in the setting of high-frequency cART nonadherence is unknown. Methods Peripheral blood total HIV DNA from 164 early treated (day 0–21 of life) IU HIV-infected South African infants was measured using droplet digital PCR at birth and following suppressive cART. We evaluated the impact of cART initiation timing on HIV reservoir size and decay, and on the risk of subsequent plasma viremia in cART-suppressed infants. Results Baseline HIV DNA (median 2.8 log10 copies/million peripheral blood mononuclear cells, range 0.7–4.8) did not correlate with age at cART initiation (0–21 days) but instead with maternal antenatal cART use. In 98 infants with plasma viral suppression on cART, HIV DNA half-life was 28 days. However, the probability of maintenance of plasma aviremia was low (0.46 at 12 months) and not influenced by HIV DNA load. Unexpectedly, longer time to viral suppression was associated with protection against subsequent viral rebound. Conclusions With effective prophylaxis against mother-to-child transmission, cART initiation timing in the first 3 weeks of life is not critical to reservoir size.