Prevention of Mother-to-Child HIV Transmission Is Key for Reducing Neonate’s Viral Load

Initiating combination antiretroviral therapy (cART) in pregnant women before birth significantly impacts HIV DNA viral load among infants infected with HIV in utero, according to a new study.

“With effective prophylaxis against mother-to-child transmission, cART initiation timing in the first 3 weeks of life is not critical to reservoir size,” the researchers wrote.

For their study, the researchers evaluated the impact of cART initiation timing on HIV reservoir size and decay, as well as the impact on the risk of subsequent plasma viremia in infants with cART suppression. HIV DNA viral load was assessed via polymerase chain reaction test at birth and after cART suppression.

Included in the analysis were 164 infants who were infected with HIV in utero and were treated with cART within 21 days of life. Results showed that baseline HIV DNA viral load did not correspond to age of cART initiation. However, it did correspond to maternal antenatal cART use.

“In conclusion, where [prevention of mother-to-child transmission] programs are implemented well, and the standard of care can achieve HIV diagnosis at birth and cART initiation within the first 3 weeks of life, the priority for [in utero] HIV-infected infant cART initiation should be timed to maximize caregiver adherence to achieve and sustain viral suppression, rather than aiming for lower HIV DNA as a hallmark of HIV remission,” the researchers wrote.

—Amanda Balbi


Millar JR, Bengu N, Vieira VA, et al. Early initiation of antiretroviral therapy following in utero HIV infection is associated with low viral reservoirs but other factors determine viral rebound. J Infect Dis. 2021;224(11):1925-1934.