Journal article
Delayed HIV detection among infants exposed to postnatal antiretroviral prophylaxis during breastfeeding
AIDS (London), Vol.29(15), pp.1953-1961
09/24/2015
DOI: 10.1097/QAD.0000000000000794
PMCID: PMC4665628
PMID: 26153671
Abstract
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.
Details
- Title: Subtitle
- Delayed HIV detection among infants exposed to postnatal antiretroviral prophylaxis during breastfeeding
- Creators
- Caroline C. King - Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, Atlanta, GA 30341 USAAthena P. Kourtis - Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, Atlanta, GA 30341 USADeborah Persaud - Johns Hopkins UniversityJulie A. E. Nelson - University of North Carolina at Chapel HillCarrie Ziemniak - Johns Hopkins UniversityMichael G. Hudgens - University of North Carolina at Chapel HillGerald Tegha - University of MalawiCharles S. Chasela - University of the WitwatersrandDenise J. Jamieson - Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, Atlanta, GA 30341 USACharles M. van der Horst - University of North Carolina at Chapel Hill
- Resource Type
- Journal article
- Publication Details
- AIDS (London), Vol.29(15), pp.1953-1961
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/QAD.0000000000000794
- PMID
- 26153671
- PMCID
- PMC4665628
- ISSN
- 0269-9370
- eISSN
- 1473-5571
- Number of pages
- 9
- Grant note
- American Recovery and Reinvestment Act Elizabeth Glaser Pediatric AIDS Foundation R24 HD050924 / Carolina Population Center U.S. Agency for International Development; United States Agency for International Development (USAID) SIP 13-01 U48-CCU409660-09; SIP 26-04 U48-DP000059-01; SIP 22-09 U48-DP001944-01 / Prevention Research Centers Special Interest Project of the CDC World Food Programme OPP53107 / Bill & Melinda Gates Foundation; CGIAR Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA R01 HD080474; P30 AI094189 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA P30-AI50410 / University of North Carolina Center for AIDS Research National Institute of Allergy and Infectious Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) Malawi Ministry of Health and Population D43 TW001039; R24 TW007988 / National Institutes for Health Fogarty International Center (AIDS International Training and Research Program and Scholars and Fellows Program) United Nations Children's Fund
- Language
- English
- Date published
- 09/24/2015
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446282702771
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