Delayed HIV detection among infants exposed to postnatal antiretroviral prophylaxis during breastfeeding

Details

• Alternative Title:
  AIDS
• Personal Author:
  King, Caroline C. ; Kourtis, Athena P. ; Persaud, Deborah ; Nelson, Julie A.E. ; Ziemniak, Carrie ; Hudgens, Michael G. ; Tegha, Gerald ; Chasela, Charles S. ; Jamieson, Denise J. ; van der Horst, Charles M.
• 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.
  
  
• Keywords:
  Anti-Retroviral Agents Antiretroviral Breastfeeding Breast Feeding Delayed Diagnosis Detection Diagnostic Tests, Routine Genotyping Techniques HIV HIV Infections Humans Infant Infant, Newborn Infectious Disease Transmission, Vertical Molecular Epidemiology

  More +
• Source:
  AIDS. 29(15):1953-1961
• Pubmed ID:
  26153671
• Pubmed Central ID:
  PMC4665628
• Document Type:
  Journal Article
• Funding:
  SIP 22-09 U48-DP001944-01/DP/NCCDPHP CDC HHSUnited States/ ; D43 TW001039/TW/FIC NIH HHSUnited States/ ; U48DP001944/ACL HHSUnited States/ ; P30 AI094189/AI/NIAID NIH HHSUnited States/ ; SIP 26-04 U48-DP000059-01/DP/NCCDPHP CDC HHSUnited States/ ; R01 HD080474/HD/NICHD NIH HHSUnited States/ ; R21 AI100656/AI/NIAID NIH HHSUnited States/ ; R24 TW007988/TW/FIC NIH HHSUnited States/ ; P30-AI50410/AI/NIAID NIH HHSUnited States/ ; R24 HD050924/HD/NICHD NIH HHSUnited States/ ; SIP 13-01U48-CCU409660-09/PHS HHSUnited States/ ; R24HD050924/HD/NICHD NIH HHSUnited States/ ; U48 DP000059/DP/NCCDPHP CDC HHSUnited States/ ; P30 AI050410/AI/NIAID NIH HHSUnited States/
• Volume:
  29
• Issue:
  15
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:acb219a48c039d3da29f140c0db1b71560918ca0bf98a05203b1ccf88b76f8bd
• Download URL:
  https://stacks.cdc.gov/view/cdc/36249/cdc_36249_DS1.pdf
• File Type:
  [PDF - 608.86 KB ]