ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Early treatment of HIV restricts the size of the pro-viral reservoir
It is known that combined Antiretroviral therapy(cART) before 6 weeks of age results in low levels of HIV .
If treatment starts before 1 year of age, there is a median of 4 copies at 10 yrs of age.
Treatment within first 48 hrs(& first 4 days of life), most will clear the virus before 4 months. Most of the virus is in transient memory cells, rather than central memory cells. The Missisipi baby was infected in utero but treatment was initiated within 31 hrs and discontinued at 18 mths. This baby remained in remission for 28 mths off cART.
Very early cART alters HIV persistence in children. It limits pro viral and replication competent reservoirs.
In adults, we are still determining what undetectable HIV (when being treated with ART) really means., and how early is the ideal time to start treatment.
In HIV infection, there is a massive expansion of HIV in lymphoid tissue but with treatment it is undetectable in the bloodstream. There may be decreased intracellulardrug concentration in lymphatic tissue And this may be the site of clones that expand when cART is stopped or if there is poor adherence to ART medications for whatever reason