A single injection at birth could shield children from HIV for years, a study has suggested.
The study is one of the first to show that the first weeks of life offer a critical window where the immune system is naturally more tolerant, meaning it is the optimal time to deliver gene therapies that would otherwise be rejected at older ages.
Researchers hope the gene therapy jab could be used in the future to fight against paediatric infections in high-risk areas.
“Nearly 300 children are infected with HIV each day,” said first author Amir Ardeshir, associate professor of microbiology and immunology at the Tulane National Primate Research Center in the US.
“This approach could help protect newborns in high-risk areas during the most vulnerable period of their lives.”
The study, published in the journal Nature, created a gene therapy that programs cells to produce HIV-fighting antibodies.
An animal study that tested the injection on non-human primates found it protected them from infection for at least three years without the need for a booster shot. But this was only if the injection was administered in the first month of life.
In comparison, those that received the gene therapy between eight and 12 weeks after birth did not tolerate the treatment, study authors explain.
“This is a one-and-done treatment that fits the critical time when these mothers with HIV in resource-limited areas are most likely to see a doctor,” Dr Ardeshir said.
“As long as the treatment is delivered close to birth, the baby’s immune system will accept it and believe it’s part of itself.”
Globally, an estimated 1.3 million women and girls living with HIV become pregnant every year, according to the World Health Organization (WHO).
But if they do not receive medication, the rate of transmission of HIV from the mother to her child either during pregnancy, labour, delivery or breastfeeding ranges between 15 per cent and 45 per cent, according to WHO data.
Although antiviral treatments can suppress the virus and limit transmission, adherence to treatment and doctor visits decline after childbirth, particularly in areas with limited access to healthcare, the study authors noted.
This gene therapy uses a harmless virus that can deliver genetic code to cells, but is different to a vaccine. This virus was injected into muscle cells and delivered instructions to produce antibodies that are capable of neutralising multiple strains of HIV.
Researchers explained that previous studies have found repeated infusions of the injection are needed for it to work.
But by injecting it into muscle cells, researchers say they become “micro-factories that just keep producing these antibodies”.
Newborns showed greater tolerance to the jab, which prevented infection during breastfeeding. However, older infants and juveniles were more likely to have produced anti-drug antibodies that shut down the treatment.
In addition, exposing a foetus to the antibodies from the gene therapy before birth helps older infants accept the therapy.
However, because it has only been tested on animals, researchers still do not know if it will work on human children.
If successful, this treatment could dramatically reduce mother-to-child HIV transmission rates in high-risk regions such as sub-Saharan Africa, where 90 per cent of paediatric HIV cases can be found.
“Nothing like this was possible to achieve even 10 years ago,” Dr Ardeshir said. “This was a huge result, and now we have all the ingredients to take on HIV.”
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