Analytical treatment interruption in children living with HIV: position statement from the EPIICAL consortium.

Journal

The lancet. HIV
ISSN: 2352-3018
Titre abrégé: Lancet HIV
Pays: Netherlands
ID NLM: 101645355

Informations de publication

Date de publication:
23 Jul 2024
Historique:
received: 01 02 2024
revised: 16 05 2024
accepted: 12 06 2024
medline: 27 7 2024
pubmed: 27 7 2024
entrez: 26 7 2024
Statut: aheadofprint

Résumé

Analytical treatment interruption (ATI) is widely acknowledged as an essential component of studies to advance our understanding of HIV cure, but discussion has largely been focused on adults. To address this gap, we reviewed evidence related to the safety and utility of ATI in paediatric populations. Three randomised ATI trials using CD4 T-cell and clinical criteria to guide restart of antiretroviral therapy (ART) have been conducted. These trials found low risks associated with ATI in children, including reassuring findings pertaining to neurocognitive outcomes. Similar to adults treated during acute infection, infants treated early in life have shifts in virological and immunological parameters that increase their likelihood of achieving ART-free viral control. Early ART limits the size and diversity of the viral reservoir and shapes effective innate and HIV-specific humoral and cellular responses. Several cases of durable ART-free viral control in early treated children have been reported. We recommend that, where appropriate for the study question and where adequate monitoring is available, ATI should be integrated into ART-free viral control research in children living with HIV. Paediatric participants have the greatest likelihood of benefiting and potentially the most years to prospectively realise those benefits. Excluding children from ATI trials limits the evidence base and delays access to interventions.

Identifiants

DOI: 10.1016/S2352-3018(24)00157-7 PMID: 39059402
pubmed: 39059402
pii: S2352-3018(24)00157-7
doi: 10.1016/S2352-3018(24)00157-7
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

Déclaration de conflit d'intérêts

Declaration of interests DP reports support from the National Institutes of Health (NIH), being the recipient of the 2023 Jonathan Lax Lectureship sponsored by the BEAT Martin Delaney Collaboratory and Wistar Institute in Philadelphia, and being on the scientific advisory board of ViiV Healthcare and the Elizabeth Glaser Pediatric AIDS Foundation. PP reports grant support from the NIH-Pediatric Adolescent Virus Elimination project (May, 2020, to May, 2025) and the National Institute of Allergy and Infectious Diseases ([NIAID] grant U01AI135941, Targeting HIV reservoirs in children with HIVIS-DNA and MVA-CMDR vaccines) and being a founder of Probiomics (Tor Vergata University of Rome). PRos reports consulting fees from Achilles Vaccines and being on the board of directors of the PENTA Foundation. All other authors declare no competing interests.

Auteurs

Louise Kuhn (L)

Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA. Electronic address: lk24@cumc.columbia.edu.

Shaun Barnabas (S)

Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa.

Nicola Cotugno (N)

Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.

Holly Peay (H)

RTI International, Durham, NC, USA.

Philip Goulder (P)

Department of Paediatrics, University of Oxford, Oxford, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Africa Health Research Institute, Durban, South Africa; Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA.

Mark Cotton (M)

Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa.

Avy Violari (A)

Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Savita Pahwa (S)

Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA.

Kavidha Reddy (K)

Africa Health Research Institute, Durban, South Africa.

Alfredo Tagarro (A)

Fundación de Investigación Biomédica, Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre, Madrid, Spain; Department of Pediatrics, Infanta Sofía University Hospital, Fundación para la Investigación Biomédica e Innovación Hospital Universitario Infanta Sofía y Hospital del Henares, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.

Kennedy Otwombe (K)

Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Samantha Fry (S)

Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa.

Paula Vaz (P)

Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique.

Maria Grazia Lain (MG)

Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique.

Tacilta Nhampossa (T)

Centro de Investigação em Saúde de Manhiç, Maputo, Mozambique.

Moherndran Archary (M)

Africa Health Research Institute, Durban, South Africa; Department of Paediatrics and Department of Infectious Diseases, University of KwaZulu Natal, Durban, South Africa.

Almoustapha Issiaka Maiga (AI)

Department of Medical Biology, CHU Gabriel Toure, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali.

Thanyawee Puthanakit (T)

Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Cissy M Kityo (CM)

Joint Clinical Research Centre, Kampala, Uganda.

Caroline Foster (C)

Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK.

Pablo Rojo (P)

Universidad Complutense Madrid, Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre, Madrid, Spain.

Nigel Klein (N)

Africa Health Research Institute, Durban, South Africa; Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, UK.

Eleni Nastouli (E)

Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.

Caroline T Tiemessen (CT)

Centre for HIV and STIs, National Institutes of Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Anita de Rossi (A)

Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padua, Padua, Italy.

Thumbi Ndung'u (T)

HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Africa Health Research Institute, Durban, South Africa; Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA; Division of Infection and Immunity, University College London, London, UK.

Deborah Persaud (D)

Johns Hopkins University School of Medicine; Department of Pediatrics, Division of Infectious Diseases, Baltimore, MD, USA.

Mathias Lichterfeld (M)

Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA; Infectious Disease Division, Brigham and Women's Hospital Harvard, Cambridge, MA, USA.

Carlo Giaquinto (C)

Department of Women's and Children's Health, University of Padua, Padua, Italy.

Paolo Palma (P)

Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.

Paolo Rossi (P)

Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.

Classifications MeSH