WHO welcomes a new case report, which found an HIV-infected infant treated with triple antiretroviral drugs in the first 30 hours of life appeared to be functionally cured after taking treatment for 18 months, but notes the need for more studies to confirm and replicate the findings.
These findings were presented today at the 20th Conference on Retroviruses and Opportunistic Infections (CROI) held in Atlanta the United States of America.
The report states that the mother, who was living with HIV when the baby was born, had not received antiretroviral medication or prenatal care. Researchers report that because of the high risk of HIV transmission, the baby was put on a triple therapy regimen of antiretroviral drugs at 30 hours of life, using treatment doses. Blood test results showed that on two separate specimens, the infant was found to have detectable virus (HIV DNA and HIV RNA) prior to starting antiretroviral treatment.
According to the report, a series of viral tests during treatment showed a progressive reduction of virus in the infant’s blood, until it reached undetectable levels 29 days after birth. The infant remained on ARVs until 18 months of age, at which point the child was lost to follow-up and, the researchers say, stopped the treatment. Ten months after the interruption of treatment, the child underwent repeated standard blood tests, none of which detected virus in the blood or HIV-specific antibodies.
If the findings are confirmed this would be the first well-documented case of an HIV-infected child who appears to have no detectable levels of the virus after having taken antiretrovirals and stopped HIV treatment for a substantial period. This case highlights a possible new approach for high risk infants whose mothers have not received any treatment prior to birth.
At the end of 2011, there were an estimated 330 000 children newly infected with HIV, a 24% reduction in new infections from 2009. WHO, UNICEF and UNAIDS are committed to elimination of paediatric HIV by 2015 as outlined by the Global elimination plan. According to the latest global estimates, 28% of HIV-exposed babies (infants born to HIV-infected mothers) are tested for HIV within six weeks of birth and the mean age of early testing may as high as six months. In many low- and middle-income countries, even if early infant diagnosis testing with PCR is done between 4-6 weeks as is recommended by the WHO, the turn-around time to receive the results and act upon these can be several weeks, due to the specialized testing done at central laboratories and health systems constraints.
WHO is enthusiastic about this interesting case report and looks forward to the confirmation of these results through future studies. Meanwhile, WHO will maintain the current recommendations of early HIV testing of pregnant women and provision of ARVs to all HIV positive mothers, along with infant prophylaxis, to prevent HIV transmission to the infant (PMTCT). The implications of this case study are not very clear at this point until more information becomes available. However it does point to the potential need for earlier access to HIV diagnostics to infants born to HIV positive mothers. WHO is in the process of reviewing our guidance on early infant testing (EID) in 2013 and all new data will be reviewed as it becomes available.
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