Early ART in Infants May Lead to HIV Control Without Medication

Denver – Latest research suggests that children born with HIV who begin antiretroviral therapy (ART) within the first 21 days of life may be able to control the virus without medication for extended periods, offering a potential path toward a functional cure. A study presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in February 2026, found that one-third of these infants maintained undetectable viral loads for at least 12 weeks after stopping treatment.

The Ucwaningo Lwabantwana Cohort Study

Inspired by the case of the “Mississippi baby,” researchers at the University of KwaZulu-Natal in South Africa established the Ucwaningo Lwabantwana Cohort Study. This study followed 330 mother-infant pairs living with HIV, all of whom initiated ART before 21 days of life. “Very early ART initiation means that the reservoir – the reason that HIV is so difficult to cure – in these children is very small, which is something that has been shown to help in later ability to control the virus,” explained Gabriela Z. L. Cromhout, MD, MSc, DTM&H, a physician and HIV cure researcher at the University of KwaZulu-Natal and clinical lead for the study. She also noted that early ART helps maintain the children’s immune systems, enabling them to fight off opportunistic infections.

Azaphile Study Findings

The recent Azaphile study involved 19 children (median age 59 months) who began ART within the first 21 days of life (median 10 days). Participants had to meet specific criteria to qualify for treatment interruption, including a plasma viral load below 30 c/mL for at least two years, CD4 counts above 500 c/µl (for those aged 5 years and older) or above 750 c/µl (for those aged 36 to 59 months) and HIV DNA viral loads below 20 copies per million peripheral blood mononuclear cells (PBMC).

Within six weeks of stopping treatment, 13 children experienced viral rebound. However, six children remained undetectable for at least 12 weeks. Of those six, three experienced viral rebound at 4.8, 18, and 24 months, even as the remaining three maintained undetectable viral loads at 9, 29, and 51 months, respectively.

Implications for HIV Cure Research

Dr. Cromhout highlighted the significance of these findings in comparison to adult studies, where only 4% of adults maintain undetectable viral loads after 12 weeks off treatment. “This shows us that a much larger proportion of very early treated children born with HIV are able to control HIV without medication owing to early treatment alone,” she stated. “This reinforces the idea that children are at a higher potential to be cured of HIV than adults.”

Source: Cromhout GZL, et al. Abstract 153. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2026; Denver.

Disclosure: Cromhout reports no relevant financial disclosures.