# Impact of Delayed Early Antiretroviral Therapy Initiation on Treatment Outcomes in Infant Macaques Exposed to SHIVAD8

## TL;DR

Delaying early antiretroviral treatment in infant macaques reduces chances of long-term virus control, emphasizing the need for prompt treatment.

## Contribution

The study reveals that even a two-day delay in early treatment initiation significantly impacts virologic remission in SHIV-exposed infants.

## Key findings

- Initiating treatment at five days post-exposure suppressed viral replication but only one of three infants achieved sustained remission.
- The virus-controlled infant lacked detectable virus-specific immunity, including neutralizing antibodies and cytotoxic T cell responses.

## Abstract

Infants born to HIV-positive mothers remain at significant risk of HIV acquisition despite maternal adherence to antiretroviral therapy, cesarean delivery, and formula feeding. Our previous study reported that initiating early antiretroviral treatment at three days post-SIV infection resulted in approximately eighty percent of pediatric virologic remission. In this study, we investigated treatment outcomes in postnatally SHIV-exposed infant macaques when early intervention was delayed by two days, as well as the mechanisms underlying virologic control. The results showed that, although initiating treatment at five days post-exposure effectively suppressed viral replication, only one of the three infant macaques achieved a sustained state of virologic remission following analytical treatment interruption. Notably, this virus-controlled infant lacked detectable virus-specific immunity, including neutralizing antibodies, cytotoxic T cell responses, and antibody-dependent cellular cytotoxicity. These findings highlight the critical importance of early treatment initiation as a key determinant of virologic control in HIV-exposed, infected infants. This study provides valuable insights for guiding early pediatric HIV intervention strategies in clinical settings.