Rapid decline of HIV-1 DNA and RNA in infants starting very early antiretroviral therapy may pose a diagnostic challenge.
Rapid decline of HIV-1 DNA and RNA in infants starting very early antiretroviral therapy may pose a diagnostic challenge.
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DOI：
10.1097/qad.0000000000001739
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发表时间：
2018-03-13
期刊：
影响因子：
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通讯作者：
van Zyl GU
中科院分区：
文献类型：
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作者：
Veldsman KA;Maritz J;Isaacs S;Katusiime MG;Janse van Rensburg A;Laughton B;Mellors JW;Cotton MF;van Zyl GU
HIV-1 感染的出生诊断为早期抗逆转录病毒治疗 (ART) 提供了理想的机会，以限制 HIV-1 病毒库的大小并限制疾病进展。尽管存在关于从 2-3 个月大开始治疗的儿童的细胞 HIV-1 DNA 衰减的数据，但缺乏出生后不久开始治疗的数据。我们研究了出生后 8 天内开始 ART 的婴儿，以纵向评估 HIV-1 DNA 水平。儿童是从开普敦的公共卫生诊所招募的，那里进行了 HIV-1 出生诊断并进行了早期 ART 治疗。使用针对整合酶保守区域的灵敏定量 PCR 测定总细胞 HIV-1 DNA 水平。 11 名婴儿在出生 8 天内被诊断并开始 ART，且在 ART 前可检测到 HIV-1 DNA，其中 3 名婴儿在治疗 6 天、3 个月和 4 个月后分别检测不到 HIV-1 DNA。在 7 名进行病毒学抑制（定义为血浆 HIV-1 RNA 持续下降趋势，6 个月后 <100 拷贝/mL）的患者中，总 HIV-1 DNA 在 12 个月内持续衰减（平均半衰期为 64.8 天 [95% CI：47.9–105.7]）。在出生后 8 天内开始接受 ART 的婴儿中，母亲 ART 与用于预防和治疗的早期 ART 相结合，有助于 HIV-1 感染细胞迅速下降至较低或不可检测的水平。然而，当确认性检测延迟时，HIV-1 RNA 和 DNA 的快速下降可能会使确诊变得复杂。
Birth diagnosis of HIV-1 infection offers an ideal opportunity for early antiretroviral treatment (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 2–3 months of age, data is lacking for starting shortly after birth. We studied infants who initiated ART within 8 days after birth to assess HIV-1 DNA levels longitudinally. 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. Of 11 infants diagnosed and beginning ART within 8 days of birth with detectable pre-ART HIV-1 DNA, 3 subsequently had undetectable HIV-1 DNA after 6 days, 3 months and 4 months on treatment, respectively. In 7 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% CI: 47.9–105.7]). 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.