Each year, hundreds of thousands of babies around the world are born with HIV. Though their developing immune systems make them more susceptible to rapid HIV disease progression and death, many of these children do not get tested for the virus, get tested too late, or get tested but lack access to life-saving antiretroviral therapy (ART).

In 2005, a study sponsored by NIAID with support from the departments of health of the Western Cape and Gauteng in South Africa, the London-based Medical Research Council, and GlaxoSmithKline set out to determine the best time to start ART in infants. The standard of care at that time was to begin ART in infants when they showed signs of HIV illness or a weakened immune system. The results of the Children with HIV Early Antiretroviral Therapy (CHER) study, announced in 2007 and published the following year, have helped improve this standard.

The CHER study found that testing at-risk infants for HIV and then giving ART immediately to those who test positive dramatically reduces the rates of illness and death. HIV-infected infants were four times less likely to die if given ART immediately after they were diagnosed with HIV, when compared with the standard of care.

This finding helped influence the World Health Organization (WHO) to change its guidelines for treating HIV-infected infants. The guidelines now strongly recommend starting ART in all children under age 2 immediately after they have been diagnosed with HIV, regardless of their health status.

In 2010, a clinical trial funded by NIAID and the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development found that African infants less than 3 years old had better outcomes with an ART regimen based on protease inhibitors than infants given an ART regimen based on nevirapine. The WHO currently is reviewing the results of this and other studies to determine whether to change recommendations about which treatment regimen is best for HIV-infected infants.

Father and child in a village in southern Africa. Credit: iStockphoto

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