TY - JOUR
T1 - Age at ART initiation and proviral reservoir size in perinatal HIV-1 infection
T2 - considerations for ART-free remission
AU - Bekka, Soumia
AU - Kelly, Kristen
AU - Haaren, Mareike
AU - Dhummakupt, Adit
AU - Persaud, Deborah
N1 - Publisher Copyright:
1746-630X Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Purpose of review Achieving ART-free remission without the need for lifelong antiretroviral treatment (ART) is a new objective in HIV-1 therapeutics. This review comprehensively examines the literature to evaluate whether the age at ART initiation in children with perinatal HIV-1 influences the size and decay of the HIV-1 reservoir. The insights gathered from this review serve to inform the field on the unique dynamics of HIV-1 reservoir size in perinatal HIV-1 infection as a function of age at ART initiation, as well as inform biomarker profiling and timing of ART-free remission strategies for children living with HIV-1 globally. Recent findings Recent studies demonstrate that initiating very early effective ART in neonates is feasible and limits HIV-1 reservoir size. The clinical relevance of limiting the HIV-1 reservoir size in perinatal infection was recently demonstrated in the Tatelo Study, which investigated a treatment switch from ART to two broadly neutralizing antibodies (bNAbs) in very early treated children. Low proviral reservoir size was associated with sustained virologic control for 24 weeks on bNAbs. Summary Immediate and early ART initiation for neonates and infants with perinatal HIV-1 is essential to restricting HIV-1 reservoir size that may enable ART-free remission.
AB - Purpose of review Achieving ART-free remission without the need for lifelong antiretroviral treatment (ART) is a new objective in HIV-1 therapeutics. This review comprehensively examines the literature to evaluate whether the age at ART initiation in children with perinatal HIV-1 influences the size and decay of the HIV-1 reservoir. The insights gathered from this review serve to inform the field on the unique dynamics of HIV-1 reservoir size in perinatal HIV-1 infection as a function of age at ART initiation, as well as inform biomarker profiling and timing of ART-free remission strategies for children living with HIV-1 globally. Recent findings Recent studies demonstrate that initiating very early effective ART in neonates is feasible and limits HIV-1 reservoir size. The clinical relevance of limiting the HIV-1 reservoir size in perinatal infection was recently demonstrated in the Tatelo Study, which investigated a treatment switch from ART to two broadly neutralizing antibodies (bNAbs) in very early treated children. Low proviral reservoir size was associated with sustained virologic control for 24 weeks on bNAbs. Summary Immediate and early ART initiation for neonates and infants with perinatal HIV-1 is essential to restricting HIV-1 reservoir size that may enable ART-free remission.
KW - antiretroviral therapy-free remission
KW - perinatal HIV-1 reservoirs
KW - very early antiretroviral therapy
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U2 - 10.1097/COH.0000000000000839
DO - 10.1097/COH.0000000000000839
M3 - Review article
C2 - 38169427
AN - SCOPUS:85184294576
SN - 1746-630X
VL - 19
SP - 79
EP - 86
JO - Current opinion in HIV and AIDS
JF - Current opinion in HIV and AIDS
IS - 2
ER -