Early Treatment Regimens Achieve Sustained Virologic Remission in Infant Macaques Infected with SIV at Birth

Abstract

Early antiretroviral therapy (ART) in HIV-infected infants generally fails to achieve a sustained state of ART-free virologic remission, leading to rapid viral rebound, even after years of analytical treatment interruption. Our studies showed that in contrast to adults, skewing of viral integration was observed in neonatal macaques intravenously exposed to SIV at birth. Further, one month of ART regimen combined an integrase inhibitor, initiated at day 3 but not day 4 and 5 post infection, efficiently and rapidly suppressed viremia to undetectable levels. Finally, interventions initiated at day 3 post infection for 9 months achieved a sustained virologic remission in ~80% infants. Collectively, an early intervention strategy with a key time checkpoint and regimen may resulted in viral remission for neonatal SIV infection, which may be clinically relevant for optimizing treatment strategies for HIV-infected infants.