Treating babies infected with HIV as soon as possible after birth seems to be most effective at reducing signs of the virus. Newborns given HIV treatment quickly after birth had fewer infected cells in their blood and their immune systems were less damaged than those given the treatment later.
Mathias Lichterfeld at Harvard University studied 20 babies with HIV born in Botswana. Ten of the babies received antiretroviral therapy for HIV rapidly, normally within a day of birth, and the others started treatment later, around four months after birth. The researchers then checked how the babies were doing two years after starting treatment.
The babies who received early treatment had stronger immune systems, with fewer damaged immune cells. They also had 200 times fewer dormant HIV-infected cells, which can reactivate and start replicating.
“Every day that an infant remains untreated counts and makes things worse,” says Lichterfeld. Testing and treatment should happen early, whenever it is feasible, says Roger Shapiro, part of the team and also at Harvard. Without treatment, 25 to 50 per cent of children infected with HIV die within their first two years of life.
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HIV can be transmitted from a woman to her child during pregnancy, childbirth and breastfeeding. In most cases, transmission can be prevented by giving treatment to the mother, says Shapiro. “But for the few who slip through this safety net, we owe it to them to provide diagnosis and treatment as quickly as possible,” he says.
Left untreated, HIV causes AIDS – a fatal syndrome where the body can’t fight off infections. The condition progresses more quickly in infants than it does in adults because their immune systems are still developing. Antiretroviral therapy normally prevents AIDS from developing but isn’t a cure, meaning that the drugs must be taken for life.
The immune system is “broken” by HIV infection and earlier treatment can prevent that, says Greg Towers at University College London.
The results add to a growing body of evidence that early treatment improves the outcome for children. For example, one study in 2008 found that treating children for HIV at 6 to 12 weeks old can reduce infant mortality by 76 per cent and HIV progression by 75 per cent compared with children that were treated around age 1. As a result, the World Health Organization guidelines now recommend testing for HIV at birth or soon after, and initiating treatment immediately upon diagnosis.
Journal reference: Science Translational Medicine, DOI: 10.1126/scitranslmed.aax7350
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