Lopinavir-ritonavir-based antiretroviral therapy significantly accelerated suppression of the Epstein-Barr virus among infants with HIV, according to a study in Clinical Infectious Diseases.
The study cohort consisted of 64 infants with a median age of 3.6 months who were living in Nairobi and had not received ART prior to the study. Jennifer A. Slyker, PhD, and colleagues followed study participants for a median of 24 months. The mean CD4 count was low at baseline (20%, +SD 8.3). Antiretroviral therapy began at a median age of 4.1 months; 34 participants received lopinavir-ritonavir and 30 received nevirapine.
Overall, 77% of study participants had some evidence of Epstein-Barr virus (EBV) infection and 72% had detectable EBV DNA. Nine EBV infections were detected at baseline before ART; and 18 infants tested negatively for EBV DNA throughout follow-up. The mean age at EBV infection was 8.8 months.
Among the 46 infants with detectable EBV DNA, 27 later became undetectable within a mean duration of 11 months (95% CI=7.7-14). Infants who received lopinavir-ritonavir had a shorter suppression rate (6.4 months) compared with those who received nevirapine (15 months).
Researchers categorized study participants as “good controllers” if they were EBV seropositive with no detection of EBV DNA, or had one episode of EBV DNA followed by complete suppression. “Poor controllers” had transient or persistent viremia lasting more than 3 months. Fifty-four percent of infants who received lopinavir-ritonavir were good controllers vs. 26% of those who received nevirapine; 35% of the lopinavir-ritonavir group and 61% of the nevirapine group were poor controllers.
“ART did not protect HIV-infected infants from EBV acquisition or limit peak viremia. However, lopinavir-ritonavir ART was associated with accelerated suppression of primary EBV infection … As many African countries are currently adapting their guidelines to enable earlier infant diagnosis and ART, strategic implementation of particular ART regimens could have population-level implications for EBV-associated malignancies,” Slyker and colleagues concluded.
Disclosure: The researchers report no relevant financial disclosures.