Primary HIV infection in infants: Impact of highly active antiretroviral therapy on the natural course

In the absence of any antiretroviral therapy, about one-third of infants with perinatally acquired HIV infection develop AIDS within the first months of life, while the remainder show slower disease progression. As the rate of viral replication during the first 3 months of life is strictly correlated with and predictive of disease outcome, any treatment that keeps the virus at low levels during primary infection might substantially modify the natural history of infection. Emerging data show that some infants treated early with highly active antiretroviral therapy have persistenty undetectable levels of HIV, and lack an HIV-specific immune response, despite preservation of immune functions. These findings strongly suggest that early therapeutic intervention might lead to a long-term suppression of viral replication.