PURPOSE OF REVIEW In the absence of antiretroviral therapy (ART), more than 50% of perinatally HIV-infected children die by 2 years of age. Early ART from infancy is therefore a global recommendation and significantly improves immune health, child survival, and disease outcome. However, even early treatment does not prevent or eradicate the latent reservoir necessitating life-long ART. Adherence to life-long ART is challenging for children and longstanding ART during chronic HIV infection led to higher risks of non-AIDS co-morbidities and virologic failure in infected children. Thus, HIV-infected children are an important population for consideration for immune-based interventions to achieve ART-free remission and functional cure. This review summarizes how the uniqueness of the early life immune system can be harnessed for the development of ART-free remission and functional cure, which means complete virus control in absence of ART. In addition, recent advances in therapeutics in the HIV cure field and their potential for the treatment of pediatric HIV infections are discussed. RECENT FINDINGS Preclinical studies and clinical trials demonstrated that immune-based interventions target HIV replication, limit size of virus reservoir, maintain virus suppression, and delay time to virus rebound. However, these studies have been performed so far only in carefully selected HIV-infected adults, highlighting the need to evaluate the efficacy of immune-based therapeutics in HIV-infected children and to design interventions tailored to the early life maturing immune system. Immune-based therapeutics alone or in combination with ART should be actively explored as potential strategies to achieve viral remission and functional cure in HIV-infected pediatric populations.

中文翻译：

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儿科 HIV：免疫疗法实现病毒缓解和功能治愈的潜力。

审查目的 在没有抗逆转录病毒疗法 (ART) 的情况下，超过 50% 的围产期 HIV 感染儿童在 2 岁时死亡。因此，从婴儿期开始早期 ART 是一项全球性建议，可显着改善免疫健康、儿童存活率和疾病结果。然而，即使早期治疗也不能预防或根除需要终生 ART 的潜在储库。对儿童而言，坚持终生接受抗病毒治疗是一项挑战，在慢性 HIV 感染期间长期接受抗病毒治疗会导致感染儿童出现非艾滋病合并症和病毒学失败的风险更高。因此，感染 HIV 的儿童是考虑基于免疫干预以实现无 ART 缓解和功能性治愈的重要人群。本综述总结了如何利用生命早期免疫系统的独特性来开发无 ART 缓解和功能性治愈，这意味着在没有 ART 的情况下完全控制病毒。此外，还讨论了 HIV 治愈领域治疗学的最新进展及其治疗儿科 HIV 感染的潜力。最近的发现 临床前研究和临床试验表明，基于免疫的干预措施针对 HIV 复制、限制病毒库的大小、维持病毒抑制并延迟病毒反弹的时间。然而，到目前为止，这些研究仅在精心挑选的感染 HIV 的成年人中进行，突出表明需要评估基于免疫疗法对 HIV 感染儿童的疗效，并设计针对生命早期成熟免疫系统的干预措施。