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. 2015 Jun 1;29(9):1053-60.
doi: 10.1097/QAD.0000000000000677.

Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

Louise Kuhn  1 , Diana B Schramm, Stephanie Shiau, Renate Strehlau, Francoise Pinillos, Karl Technau, Ashraf Coovadia, Elaine J Abrams, Adrian Puren, Caroline T Tiemessen
Affiliations

Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

Louise Kuhn et al. AIDS. .

Abstract

Background: Negative results on standard HIV antibody tests have been described among HIV-infected children suppressed on antiretroviral therapy (ART) started early in life. Here, we describe the frequency and predictors of this phenomenon in a well characterized cohort of treated children.

Methods: We selected samples from 103 HIV-infected children who started ART 14 months of age or less and from 122 children who started 6 months of age or less followed as part of two sequential clinical trials in Johannesburg, South Africa. Children had attained viral suppression on ART and had received ART for between 3 and 6.4 years (mean 4.3 years) when tested for HIV antibody using a standard ELISA (Genescreen HIV1/2 version 2; Bio-rad).

Results: Only children 6 months of age or less when ART was started had negative antibody results when tested after suppression on ART several years later. Negative or low-positive antibody results were observed in 40.0, 37.0 and 27.8% of children starting ART less than 2 months of age, or starting during month 2 or 3, respectively. This dropped to 5.9, 3.5 and 5.3% if ART was started during month 4, 5 and 6, respectively. Higher CD4 percentage prior to ART initiation and no recorded intermittent viremia also predicted negative antibody results.

Conclusion: Testing negative on standard HIV antibody tests occurs fairly commonly among HIV-infected children who started ART 3 months of age or less and are virally suppressed. It would be prudent in clinical practice to avoid HIV antibody tests among virally suppressed, early-treated children to prevent unnecessary confusion.

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Figures

Figure 1
Figure 1. Optical density on HIV antibody test by age at antiretroviral therapy start (months) among 218 HIV-infected children suppressed on treatment for 4–5 years
Note: Excluded those not suppressed (N = 7)
Figure 2
Figure 2
Prevalence of negative and low-positive HIV antibody results by age at antiretroviral therapy (ART) start (months) among 218 HIV-infected children suppressed on ART for ~4 years.
See this image and copyright information in PMC

References

    1. Gutierrez M, Ludwig DA, Khan SS, et al. Has highly active antiretroviral therapy increased the time to seroreversion in HIV exposed but uninfected children? Clin Infect Dis. 2012;55:1255–61. - PMC - PubMed
    1. Creek TL, Sherman GG, Nkengasong J, et al. Infant human immunodeficiency virus diagnosis in resource-limited settings: issues, technologies, and country experiences. Am J Obstet Gynecol. 2007;197:S64–71. - PubMed
    1. Desai N, Mathur M, Abu-Lawi K. HIV-1 seronegativity in a child with proved perinatal HIV infection on HAART. Sex Transm Infect. 2005;81:377–9. - PMC - PubMed
    1. Luzuriaga K, McManus M, Catalina M, et al. Early therapy of vertical human immunodeficiency virus type 1 (HIV-1) infection: control of viral replication and absence of persistent HIV-1-specific immune responses. J Virol. 2000;74:6984–91. - PMC - PubMed
    1. Van der Linden D, Hainaut M, Goetghebuer T, et al. Effectiveness of early initiation of protease inhibitor-sparing antiretroviral regimen in human immunodeficiency virus-1 vertically infected infants. Pediatr Infect Dis J. 2007;26:359–61. - PubMed

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