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Delayed HIV detection among infants exposed to postnatal antiretroviral prophylaxis during breastfeeding
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Details:
  • Pubmed ID:
    26153671
  • Pubmed Central ID:
    PMC4665628
  • Funding:
    D43 TW001039/TW/FIC NIH HHS/United States
    D43 TW001039/TW/FIC NIH HHS/United States
    P30 AI050410/AI/NIAID NIH HHS/United States
    P30 AI094189/AI/NIAID NIH HHS/United States
    P30 AI094189/AI/NIAID NIH HHS/United States
    P30-AI50410/AI/NIAID NIH HHS/United States
    R01 HD080474/HD/NICHD NIH HHS/United States
    R01 HD080474/HD/NICHD NIH HHS/United States
    R21 AI100656/AI/NIAID NIH HHS/United States
    R24 HD050924/HD/NICHD NIH HHS/United States
    R24 TW007988/TW/FIC NIH HHS/United States
    R24 TW007988/TW/FIC NIH HHS/United States
    R24HD050924/HD/NICHD NIH HHS/United States
    SIP 13-01U48-CCU409660-09/PHS HHS/United States
    SIP 22-09 U48-DP001944-01/DP/NCCDPHP CDC HHS/United States
    SIP 26-04 U48-DP000059-01/DP/NCCDPHP CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    The objective of this study is to determine whether detection of HIV infection was delayed in infants exposed to antiretroviral prophylaxis to prevent HIV transmission during breastfeeding.

    Design

    The Breastfeeding, Antiretrovirals and Nutrition (BAN) study was a randomized trial of 2369 mother–infant pairs conducted from 2004 to 2010. In addition to an intrapartum regimen, all mother–infant pairs were randomly assigned to three antiretroviral intervention arms during 28 weeks of breastfeeding: no further antiretroviral prophylaxis (control arm); infant-daily nevirapine (nevirapine arm); and maternal zidovudine, lamivudine and either nevirapine, nelfinavir or lopinavir-ritonavir (maternal arm). After breastfeeding cessation counselling and stopping the antiretroviral interventions by 28 weeks, 28 infant HIV infections occurred.

    Methods

    To determine whether these infections occurred during the breastfeeding and antiretroviral intervention phase but had delayed detection on the antiretroviral arms, we performed ultrasensitive (droplet digital PCR) HIV testing on infants with stored peripheral blood mononuclear cell (PBMC) specimens at 24 weeks (n = 9).

    Results

    Of the nine infants, all three on the infant nevirapine arm had detectable HIV DNA at 24 weeks, compared with two of four on the maternal antiretroviral arm and one of two on the control arm. For infants with detectable HIV at 24 weeks, the median delay in detection between the ultrasensitive and standard assays was 18.3 weeks for the nevirapine arm, 15.4 weeks for the maternal arm and 9.4 weeks for the control arm.

    Conclusion

    The prolonged inability to detect HIV with standard assays in the context of postnatal antiretroviral prophylaxis suggests that early antiretrovirals may restrict HIV replication sufficiently to lead to missed diagnosis among infected infants. Therefore, repeat virologic testing is warranted beyond the WHO-recommended point of testing at 6 weeks after breastfeeding cessation.