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Virologic response to ART varies among HIV–infected infants
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SEATTLE — Virologic response to early ART differs among HIV–infected neonates, suggesting that clinical and social challenges influence the care they receive, according to findings presented at the annual Conference on Retroviruses and Opportunistic Infections.
“Studies in both adults and children have identified the time of acute infection as a critical window to introduce antiretroviral therapy, [which] may lead to a reduction in the size of the viral reservoir,” Louise Kuhn, PhD, professor of epidemiology at the Gertrude H. Sergievsky Center at Colombia University’s Mailman School of Public Health, said during the press conference. “Infants are a very important group who it is practical for us to identify close to the time of infection.”
Kuhn and colleagues investigated the virologic dynamics following early antiretroviral therapy (ART) in infants to determine if the initiation of ART soon after primary infection can beneficially affect virologic control. For the last 2 years, researchers have performed standard HIV polymerase chain reaction (PCR) testing on HIV–-exposed newborns at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa. To determine confirmatory testing and engagement in care, they actively traced all infants with reactive PCR results.
Infants began ART as quickly as possible with nevirapine, lamivudine and zidovudine with substitution of lopinavir/ritonavir for nevirapine at 2 weeks or older. Using Roche AmpliPrep/COBAS TaqMan with a lower detection limit (LDL) of 20 copies/mL, they measured HIV RNA in plasma at frequent intervals, and repeated qualitative HIV diagnostic PCR tests.
Kuhn and colleagues enrolled 68 of 100 identified HIV–infected children into a clinical trial tracking their response to ART. Out of all enrolled infants, 34 (50%) began ART within the first 2 days of life, 17 (25%) began between 3 and 7 days, 10 (15%) between 8 and 15 days and 7 (10%) between 16 to 106 days. To assess viral response, researchers analyzed the infants who started ART between day 0 and 15 of life and were alive at 6 months into follow-up. They found that 11% of treated infants experienced high HIV RNA levels, 35% had a declining trajectory that has not reached LDL yet and 54% have dropped to LDL or target not detected (TND) of the assay.
“Over a third of the cohort achieved and sustained HIV RNA levels, which were below the detection on this assay,” Kuhn said. “We know that they’re negative on a standard diagnostic PCR result, but we still need to do more detailed, biological studies to understand what that means in the long term.” – by Savannah Demko
Reference:
Kuhn L, et al. Abstract 27. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 13-16, 2017; Seattle.
Disclosure: Kuhn reports no relevant financial disclosures.