Preventing mother-to-child transmission of HIV is key to reducing newborn viral load

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The initiation of combined antiretroviral therapy (cART) in women who are pregnant before birth has a significant impact on the viral load of HIV DNA in infants infected with HIV in utero, according to a new study.

“With effective prophylaxis against mother-to-child transmission, the timing of initiation of cART in the first 3 weeks of life is not critical for the size of the reservoir,” the researchers wrote.

For their study, the researchers assessed the impact of the timing of cART initiation on the size and degradation of the HIV reservoir, as well as the impact on the risk of subsequent plasma viraemia in infants with cART suppression. The viral load of HIV DNA was assessed using a polymerase chain reaction test at birth and after removal of cART.

The analysis included 164 infants infected with HIV in utero and treated with cART within 21 days of life. The results showed that the baseline viral load of HIV DNA did not match the age of cART initiation. However, it was consistent with the use of maternal prenatal cART.

“In conclusion, where [prevention of mother-to-child transmission] programs are well implemented, and standard of care is HIV diagnosis at birth and initiation of ART within the first 3 weeks of life, priority for [in utero] Initiation of cART in infants infected with HIV should be timed to maximize caregiver adherence to achieve and maintain viral suppression, rather than aiming for a decrease in HIV DNA as a hallmark of remission HIV, ”the researchers wrote.

—Amanda Balbi

Reference

Millar JR, Bengu N, Vieira VA, et al. Early initiation of antiretroviral therapy after HIV infection in utero is associated with weak viral reservoirs, but other factors determine viral rebound. J Infect Dis. 2021; 224 (11): 1925-1934. https://doi.org/10.1093/infdis/jiab223

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