Early antiretroviral treatment of infants to attain HIV remission

Louise Kuhn; Renate Strehlau; Stephanie Shiau; Faeezah Patel; Yanhan Shen; Karl-Günter Technau; Megan Burke; Gayle Sherman; Ashraf Coovadia; Grace M. Aldrovandi; Rohan Hazra; Wei-Yann Tsai; Caroline T. Tiemessen; Elaine J. Abrams

EClinicalMedicine (Jan 2020)

Early antiretroviral treatment of infants to attain HIV remission

Louise Kuhn,
Renate Strehlau,
Stephanie Shiau,
Faeezah Patel,
Yanhan Shen,
Karl-Günter Technau,
Megan Burke,
Gayle Sherman,
Ashraf Coovadia,
Grace M. Aldrovandi,
Rohan Hazra,
Wei-Yann Tsai,
Caroline T. Tiemessen,
Elaine J. Abrams

Affiliations

Louise Kuhn: Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States; Corresponding author at: Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032 United States.
Renate Strehlau: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Stephanie Shiau: Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
Faeezah Patel: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Yanhan Shen: Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, United States
Karl-Günter Technau: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Megan Burke: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Gayle Sherman: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Ashraf Coovadia: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Grace M. Aldrovandi: University of California, Los Angeles, CA, United States
Rohan Hazra: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
Wei-Yann Tsai: Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
Caroline T. Tiemessen: Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Elaine J. Abrams: Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States; ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States; Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, United States

Journal volume & issue: Vol. 18

Abstract

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Background: Studies in adults and children suggested that starting antiretroviral therapy (ART) soon after infection positively influences early events in HIV infection raising the possibility that remission may be achieved in some. Methods: We designed an analytic treatment interruption (ATI) trial to test the hypothesis that a sizable minority of HIV-infected neonates who initiated ART 30% which were the primary entry criteria for the ATI trial. Proportions achieving ATI eligibility criteria were similar in the 46 infants starting ART <48 h (19.6%) to 27 infants starting 2–14 days (25.9%) (p = 0.567). Interpretation: Very early ART on its own, using regimens available when the trial was designed, is insufficient to attain minimum entry criteria needed to justify our trial of ART interruption. Decisions about how quickly to start ART should be based on optimizing standard clinical outcomes rather than with the expectation that remission can be attained. Funding: NICHD/NIAID (U01HD080441), South African Research Chairs Initiative of DST and NRF (South Africa). Keywords: HIV, Neonate, Antiretroviral therapy, Remission

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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