Princess had a rough start in life. She was born HIV-infected. Her mother was often sick, and there was little family support for her own struggles with HIV. But Princess’ mother had recently started HIV treatment and planned to stay on it. She wanted to do everything possible for her daughter, so she made a decision that ultimately helped save Princess’ life: she enrolled her in a study to treat HIV infection just a few days after being born.
HIV progresses rapidly in the first year of life, wreaking havoc on an infant’s developing immune system. Although treating HIV-infected women with three active drugs in pregnancy can prevent most transmission to babies, Princess is one of almost 500 children born each day in sub-Saharan Africa who still become infected with HIV. The World Health Organization recommends starting three-drug antiretroviral treatment in infected children as early as possible, yet this goal has proved elusive in most pediatric HIV treatment programs globally.
Recent research in this field, including our new data from Botswana, suggest that initiating treatment as close to birth as possible may be the best time to treat infants. Starting in the first week of life may reduce the total amount of virus in the baby’s body, it may improve favorable immune responses to the virus, and it may prevent rapid decline in health among children who are HIV infected – 50% of whom will die within two years if untreated.
Only a handful of exposed children are currently tested for HIV and started on treatment in the first week of life. South Africa has recently changed its policy to test children at birth and 10 weeks, but it is the only country in Africa to do so. All others have policies to test babies for HIV when they reach between four and six weeks old, by which time the viral burden in the body is high and signs of a weakened immune system may be apparent.