82 Curing HIV: Is it possible with early treatment?

Abstract Background This study explores the potential for curing HIV in infants born to HIV-positive mothers by initiating antiretroviral therapy (ART) within the first 6–12 hours of life. Despite advances in reducing vertical transmission rates, children infected with HIV continue to face lifelong ART requirements due to persistent viral reservoirs. Building upon unique cases like the “Mississippi Baby,” who achieved prolonged HIV remission after early treatment, this study examines whether prompt ART initiation can lead to sustained viral suppression and, potentially, cure. Objectives Our primary objective is to assess whether early ART initiation can cure HIV in a small case series. This proof-of-concept study includes two infants who began ART within 6-12 hours of birth, achieved undetectable HIV levels, and remained off therapy while under observation. These infants will continue to undergo regular HIV PCR testing, with comprehensive data collection as detailed below in the methods section. A secondary goal is to document relevant maternal history, including the mother’s viral load at or near birth and any ART treatment received, to better understand factors contributing to HIV cure outcomes in early-treated infants. Design/Methods Methodologically, this retrospective study with potential for prospective follow-up is focused on observing long-term clinical outcomes in these patients. Since stopping ART, these infants have remained in clinical follow-up, with routine HIV PCR tests to detect any viral reemergence. If HIV RNA remains undetectable for five years post-ART discontinuation, these patients will be considered cured and discharged from care. The study will leverage routine clinical follow-up data from Care Connect, encompassing all relevant lab and clinical metrics such as birth history, initial viral loads, ART initiation and cessation details, and subsequent HIV PCR and serology results. Should additional qualifying patients arise during the study, they will be included to strengthen the evidence base. Results Our study followed two infants that were born to HIV positive mothers and were found to be HIV positive after birth. After initiating ART since 6-12 hours from birth, they have completed 2 years of ART and the treatment has now been discontinued as they achieved undetectable levels of HIV viral loads via PCR testing of blood. As of now, their repeat HIV PCR tests remain negative despite no current ART. Conclusion The absence of HIV RNA in the blood for five years post-therapy would represent a significant step toward defining functional cure parameters. Our findings could have profound implications for HIV treatment strategies in neonates, potentially reducing or even eliminating the need for lifelong ART in a subset of early-treated infants. Although limited in scale, this case series could catalyze further exploration into early intervention protocols as a feasible approach toward HIV cure in infants.

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