According to the authors of research published in Clinical Infectious Diseases, infants with perinatal HIV infection should start antiretroviral (ART) therapy before three months of age.

The authors note that guidelines recommend early combination antiretroviral therapy (cART) in infants infected with HIV.  Although the clinical benefits of early treatment are recognised, it does not prevent establishment of a reservoir of latently infected cells.  The purpose of their study was to determine if virological and immunological responses to treatment differ according to the age at which cART is started during the first year of life.

They used data from the European Infant Collaborative Group on 139 infants with perinatally acquired HIV infection (not AIDs) who started cART therapy before the age of 12 months.  They were classified into three groups according to the age at which they started cART: ≤3 months (the early-treatment group; n=96), 3–6 months (n=22), and 6–12 months (n=21; the latter 2 groups were considered the deferred-treatment group). 

The authors report that the early treatment group had a slower decline in CD4 percentages than the deferred treatment group and also a lower peak viral load, and a shorter time until viral suppression (i.e. to less than 500 log copies/mL) in the first year of life.  At six months of age, in the early and deferred groups, respectively, CD4 percentages were 43% vs. 34%, viral loads were 2.3 vs. 4.6 copies/mL, and percentages achieving virological suppression were 63% and 19% (p<0.001 for each).  At one year of age, there was a trend toward a lower viral load in the early ART group, but none of the virological and immunological differences between the two groups was statistically significant.

In their discussion, the authors note that the ‘better immunological and virological evolution’ seen in the early treatment group compared with the deferred-treatment group was no longer detectable by age 12 months, possibly because of lack of power due to sample size.  However they say that ‘it is possible that the functional competences of CD4 cells are influenced by early initiation of therapy and may maintain an impact on the clinical outcome after the age of 12 months.’ 

They conclude that ‘because early initiation of treatment in HIV vertically infected infants is now recommended in all guidelines, efforts should be made to establish the diagnosis of infection as soon as possible after birth.’