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AIDS. 2018 Mar 13;32(5):629-634. doi: 10.1097/QAD.0000000000001739.

Rapid decline of HIV-1 DNA and RNA in infants starting very early antiretroviral therapy may pose a diagnostic challenge.

Author information

1
Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town.
2
National Health Laboratory Service, Cape Town.
3
Department Paediatrics and Child Health, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town.
4
Tygerberg Children's Hospital, Cape Town, South Africa.
5
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

OBJECTIVE:

Birth diagnosis of HIV-1 infection offers an ideal opportunity for early antiretroviral therapy (ART) to limit HIV-1 reservoir size and limit disease progression. Although data on cellular HIV-1 DNA decay exist for children commencing treatment from 2 to 3 months of age, data are lacking for starting shortly after birth.

DESIGN:

We studied infants who initiated ART within 8 days after birth to assess HIV-1 DNA levels longitudinally.

METHODS:

Children were recruited from public health clinics in Cape Town where birth diagnosis of HIV-1 coupled with early ART initiation occurred. Total cellular HIV-1 DNA levels were determined using a sensitive quantitative PCR targeting a conserved region in integrase.

RESULTS:

Of 11 infants diagnosed and beginning ART within 8 days of birth with detectable pre-ART HIV-1 DNA, three subsequently had undetectable HIV-1 DNA after 6 days, 3 months and 4 months on treatment, respectively. In seven who had virologic suppression (defined as a continuous downward trend in plasma HIV-1 RNA, and <100 copies/ml after 6 months) total HIV-1 DNA continued to decay over 12 months [mean half-life of 64.8 days (95% confidence interval: 47.9-105.7)].

CONCLUSION:

In infants initiated on ART within 8 days of life the combination of maternal ART, and early ART for prophylaxis and treatment contribute to rapid decline of HIV-1 infected cells to low or undetectable levels. However, rapid decline of HIV-1 RNA and DNA may complicate definitive diagnosis when confirmatory testing is delayed.

PMID:
29334551
PMCID:
PMC5834387
DOI:
10.1097/QAD.0000000000001739
[Indexed for MEDLINE]
Free PMC Article

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