Babies with HIV + Antiretroviral Therapy = Functional Immune Systems

Although it’s been established that babies with the human immunodeficiency virus (HIV) should be treated with antiretroviral therapy (ART) as soon as possible, it’s been unclear whether the treatment leads to functional immune systems. New research from The Wistar Institute may provide insight into area of HIV management.

Obtaining a large sample on this issue has been far from easy, which has resulted in lack of evidence. However, a study published in PLOS One provided the data needed and indicated that ART is the way to go for infants with HIV for more reason than one.

“Despite the best efforts of pediatricians and pediatric nurses, insufficient samples and missed visits have been the norm for pediatric studies in developing countries,” Luis J. Montaner, MD, DVM, DPhil, The Wistar Institute, said in a news release. “Loss of data lead to loss of statistical power, so it’s extremely important to develop methods that allow us to analyze data sets where data are randomly missing.”

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The team examined 66 babies with HIV who ranged in age from 0 months to 1 year old. All of the participants started treatment either within 12 weeks of birth (42 patients) or upon disease progression (24 patients). They were compared to controls which consisted of 23 uninfected infants with ages 0 to 6 months who were born to HIV-positive mothers. The Multiple Imputation (MI) method and Bayesian model were used to evaluate the data.

Infants with HIV had greater frequency of CD4⁺ T cells with naïve phenotype and higher serum IL-7 levels than the controls. The findings showed that early ART resulted in higher CD4⁺ T cell frequency. In addition, the treatment caused lower expression of CD95 in CD8⁺ T cell and preservation of naïve T cell subsets.

“Early ART initiation in infants with perinatal HIV infection reduces immune activation and preserves an early expansion of naïve T-cells with undiminished innate cell numbers, giving greater immune reconstitution than achieved with deferred ART,” the team concluded.

In other words, early ART can help infants develop a functional immune system. So if there were any reservations about the treatment for young patients, this study provides evidence showing that it does more than just decrease their risk of mortality.

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