Viral suppression is associated with HIV-antibody level and HIV-1 DNA detectability in early treated children at 2 years of age.
Viral suppression is associated with HIV-antibody level and HIV-1 DNA detectability in early treated children at 2 years of age.
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DOI：
10.1097/qad.0000000000002861
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发表时间：
2021-07-01
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;Laughton B;Janse van Rensburg A;Zuidewind P;Dobbels E;Barnabas S;Fry S;Cotton MF;van Zyl GU
现在，早期婴儿艾滋病毒诊断和抗逆转录病毒治疗（ART）开始在出生后不久进行。维持和监测 ART 依从性很困难，需要经常就诊。因此，我们研究了 HIV 抗体和 HIV-1 DNA 水平是否是累积病毒血症的标志。我们对 31 名出生后不久开始抗逆转录病毒治疗的儿童进行了一项横断面调查，调查对象为 2 岁儿童的 HIV 抗体和 HIV-1 DNA 水平。 HIV 抗体通过 Abbott® ARCHITECT® HIV Ag/Ab Combo 和 Geenius HIV 1/2 补充检测的组合进行测量；使用针对 HIV-1 整合酶基因的灵敏 qPCR 检测对总 HIV-1 DNA 进行定量。婴儿暴露后预防包括在出生 1 天内使用齐多夫定 (AZT) 和奈韦拉平 (NPV)（或仅在一名儿童中使用 NVP），在阳性诊断后过渡到 3 种药物 ART，中位时间 (IQR) 为 7 (4-9.5) 天。 31 名儿童中有 12 名的 HIV 血浆病毒载量 (HIVVL) 得到良好抑制，其余时期的病毒血症（ART 3 个月后 HIVVL > 100 拷贝/mL）被归类为非抑制。 24 个月大时：11/12 (92%) 的良好抑制儿童的 HIV-1 抗体检测不到，而未抑制的儿童为 3/19 (16%) (p<0.001)；7/12 (58%) 的良好抑制儿童的 HIV-1 DNA 检测不到，而未抑制的儿童为 3/19 (16%) （p=0.02）。考虑到检测成本低，以及在 2 岁时未检测到抗体水平的良好抑制儿童的比例很高，HIV 抗体水平可能是出生后不久开始治疗的儿童累积依从性的一个有价值的标志，并可能促进依从性和病毒载量调查。
Early infant HIV diagnosis and antiretroviral therapy (ART) initiation are now implemented shortly after birth. Maintaining and monitoring ART adherence is difficult and requires frequent visits. We therefore investigated whether HIV antibodies and HIV-1 DNA levels are markers of cumulative viremia. We conducted a cross sectional investigation at 2-years-of-age of HIV antibodies and HIV-1 DNA levels in a well-characterized cohort of 31 children who started ART shortly after birth. HIV antibodies were measured by a combination of the Abbott® ARCHITECT® HIV Ag/Ab Combo and Geenius HIV 1/2 supplemental assays; and total HIV-1 DNA quantified using a sensitive qPCR assay targeting the HIV-1 integrase gene. Infant post exposure prophylaxis consisted of zidovudine (AZT) and nevirapine (NPV) (or NVP only, in one child) within 1 day of birth, transitioning, after positive diagnosis, to 3 drug ART, at a median (IQR) of 7 (4-9.5) days. Twelve of 31 children had well-suppressed HIV plasma viral loads (HIVVL) and the remainder periods of viremia (HIVVL > 100 copies/mL after 3 months of ART), classified as non-suppressed. At 24-months-of-age: 11/12 (92%) of well-suppressed children had undetectable HIV-1 antibodies versus 3/19 (16%) non-suppressed children (p<0.001) and 7/12 (58%) well-suppressed children had undetectable HIV-1 DNA versus 3/19 (16%) of non-suppressed children (p=0.02). Considering low assay costs and the high proportion of well-suppressed children with undetected antibody levels at 2 years, HIV antibody levels may be a valuable marker of cumulative adherence in children who start treatment shortly after birth and could prompt adherence and viral load investigation.