Critical Advances in the Prevention of Pediatric HIV Infections

guest post by Robert T. Maupin, Jr.

This past week has born witness to reports of a groundbreaking medical breakthrough in HIV treatment resulting in the reported “cure” of an infant believed to have a pregnancy-acquired early HIV infection. The infant described in the New York Times report was born to a mother who was not diagnosed with HIV infection until shortly after she gave birth. Following the woman’s diagnosis, the infant was treated with an aggressive three drug antiretroviral regimen. The infant was reported to have remained on treatment during its first 18 months of life, and was recently determined to have cleared the infection.

HIV infectious disease experts think that this finding may signal critical new advances in the understanding of the prevention of pediatric infections. Perhaps it even holds the promise of curing early pediatric infections. However, many experts stress the need for caution in interpreting the report’s findings. Whether or not the infant definitely had an established HIV infection, as well as whether or not this clinical finding can be replicated, will require extensive follow-up and further analysis.

The prevention of pediatric HIV infections associated with pregnancy is one of the greatest advances in clinical medicine that we have witnessed during the course of the HIV/AIDS epidemic. Over the last decade, we have seen that the use of effective combination antiretroviral therapy during pregnancy for women living with or newly diagnosed with HIV infection dramatically reduces the risk of infant transmission to less than 2%. In the past year, important clinical studies demonstrated that, even for women who lacked adequate access to treatment prior to labor, aggressive multidrug antiretroviral therapy with the newborn can reduce transmission risk to close to 2%. Now, in the U.S., fewer than 200 infants exposed to HIV at birth are infected on a yearly basis.

It will take time to determine if this new case truly proves to be an example of a true HIV “cure.” However, what’s most important about this story is that it highlights tremendously important advances which allow us to believe that the elimination of pediatric HIV infections is achievable and is very much in sight.

clark HIV 2nd ed chosen comp rev.inddRobert T. Maupin, Jr., M.D., FACOG, is professor of clinical obstetrics and gynecology in the Maternal/Fetal Medicine section of the Louisiana State University Health Science Center and coauthor of A Woman’s Guide to Living with HIV Infection, published by the JHU Press.

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