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Klein N, Palma P, Luzuriaga K, Pahwa S, Nastouli E, Gibb DM, Rojo P, Borkowsky W, Bernardi S, Zangari P, Calvez V, Compagnucci A, Wahren B, Foster C, Munoz-Fernández MÁ, De Rossi A, Ananworanich J, Pillay D, Giaquinto C, Rossi P. Early antiretroviral therapy in children perinatally infected with HIV: a unique opportunity to implement immunotherapeutic approaches to prolong viral remission. THE LANCET. INFECTIOUS DISEASES 2015; 15:1108-1114. [PMID: 26187030 DOI: 10.1016/s1473-3099(15)00052-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 02/02/2023]
Abstract
From the use of antiretroviral therapy to prevent mother-to-child transmission to the possibility of HIV cure hinted at by the Mississippi baby experience, paediatric HIV infection has been pivotal to our understanding of HIV pathogenesis and management. Daily medication and indefinite antiretroviral therapy is recommended for children infected with HIV. Maintenance of life-long adherence is difficult and the incidence of triple-class virological failure after initiation of antiretroviral therapy increases with time. This challenge shows the urgent need to define novel strategies to provide long-term viral suppression that will allow safe interruption of antiretroviral therapy without viral rebound and any associated complications. HIV-infected babies treated within a few days of birth have a unique combination of a very small pool of integrated viruses, a very high proportion of relatively HIV resistant naive T cells, and an unparalleled capacity to regenerate an immune repertoire. These features make this group the optimum model population to investigate the potential efficacy of immune-based therapies. If successful, these investigations could change the way we manage HIV infection.
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Affiliation(s)
- Nigel Klein
- Institute of Child Health, University College London, London, UK.
| | - Paolo Palma
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - Katherine Luzuriaga
- Program in Molecular Medicine, University of Massachusetts Medical School Worcester, MA, USA
| | - Savita Pahwa
- Miami Center for AIDS Research Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Eleni Nastouli
- Department of Virology, University College London, London, UK
| | - Diane M Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | - Pablo Rojo
- Department of Pediatrics, Hospital 12 de Octubre, Madrid, Spain
| | | | - Stefania Bernardi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - Paola Zangari
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - Vincent Calvez
- Pierre et Marie Curie University and Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandra Compagnucci
- Institut National de la Santé et de la Recherche Médicale SC10-US019 Clinical Trials and Infectious Diseases, Villejuif, Paris, France
| | - Britta Wahren
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Foster
- Imperial College Healthcare National Health Service Trust, London, UK
| | | | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, and Istituto Oncologico Veneto, Padova, Italy
| | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research and Henry M Jackson Foundation for the Advancement of Military Medicine, Silver Spring, MD, USA
| | - Deenan Pillay
- Africa Centre, Mtubatuba, KwaZulu Natal, South Africa
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, and Penta Foundation, Padova, Italy
| | - Paolo Rossi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy.
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