aDepartment of Biostatistics and Epidemiology, University of Massachusetts-Amherst, Amherst, Massachusetts bDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland cDivision of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia dDivision of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston eDepartment of Immunology and Infectious Diseases, Harvard University, T. H. Chan School of Public Health, Boston, Massachusetts, USA fBotswana Harvard AIDS Institute Partnership, Gaborone, Botswana gUniversity College Institute of Child Health, London, UK hInstitut de recherche pour le développement (IRD) UMI 174-PHPT, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand iDepartment of Biostatistics, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA jVirus Reference Department, National Infection Service, Public Health England, London, UK kDepartment of HIV/AIDS, World Health Organization, Geneva, Switzerland lDepartment of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa mSection of Infectious Diseases and International Health, Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Lebanon, New Hampshire nCenter for Biostatistics in AIDS Research, Harvard University T. H. Chan School of Public Health. Boston, Massachusetts, USA.
AIDS. 2017 Nov 28;31(18):2465-2474. doi: 10.1097/QAD.0000000000001640.
To evaluate the association of type and timing of prophylactic maternal and infant antiretroviral regimen with time to first positive HIV-1 DNA PCR test, in nonbreastfed HIV-infected infants, from populations infected predominantly with HIV-1 non-B subtype virus.
Analysis of combined data on nonbreastfed HIV-infected infants from prospective cohorts in Botswana, Thailand, and the United Kingdom (N = 405).
Parametric models appropriate for interval-censored outcomes estimated the time to first positive PCR according to maternal or infant antiretroviral regimen category and timing of maternal antiretroviral initiation, with adjustment for covariates.
Maternal antiretroviral regimens included: no antiretrovirals (n = 138), single-nucleoside analog reverse transcriptase inhibitor (n = 165), single-dose nevirapine with zidovudine (n = 66), and combination prophylaxis with 3 or more antiretrovirals [combination antiretroviral therapy (cART), n = 36]. Type of maternal/infant antiretroviral regimen and timing of maternal antiretroviral initiation were each significantly associated with time to first positive PCR (multivariate P < 0.0001). The probability of a positive test with no antiretrovirals compared with the other regimen/timing groups was significantly lower at 1 day after birth, but did not differ significantly after age 14 days. In a subgroup of 143 infants testing negative at birth, infant cART was significantly associated with longer time to first positive test (multivariate P = 0.04).
Time to first positive HIV-1 DNA PCR in HIV-1-infected nonbreastfed infants (non-B HIV subtype) may differ according to maternal/infant antiretroviral regimen and may be longer with infant cART, which may have implications for scheduling infant HIV PCR-diagnostic testing and confirming final infant HIV status.
评估预防母婴抗逆转录病毒方案的类型和时机与未母乳喂养的 HIV 感染婴儿首次 HIV-1 DNA PCR 检测阳性时间之间的关联，这些婴儿来自主要感染 HIV-1 非 B 亚型病毒的人群。
对博茨瓦纳、泰国和英国前瞻性队列中未母乳喂养的 HIV 感染婴儿的合并数据进行分析（N=405）。
根据母婴抗逆转录病毒方案类别和母婴抗逆转录病毒起始时间，使用适用于区间 censored 结局的参数模型来估计首次 PCR 阳性时间，并对协变量进行调整。
母婴抗逆转录病毒方案包括：无抗逆转录病毒治疗（n=138）、单核苷酸类似物逆转录酶抑制剂（n=165）、单剂量奈韦拉平联合齐多夫定（n=66）和联合使用 3 种或更多种抗逆转录病毒药物的方案[联合抗逆转录病毒治疗（cART），n=36]。母婴抗逆转录病毒方案的类型和母婴抗逆转录病毒起始时间均与首次 PCR 阳性时间显著相关（多变量 P<0.0001）。与其他方案/时间组相比，出生后 1 天无抗逆转录病毒药物治疗组检测呈阳性的可能性显著降低，但在 14 天龄后差异无统计学意义。在 143 例出生时检测为阴性的婴儿亚组中，婴儿 cART 与首次检测阳性时间较长显著相关（多变量 P=0.04）。
HIV-1 感染未母乳喂养的婴儿（非 B HIV 亚型）首次 HIV-1 DNA PCR 检测阳性时间可能因母婴抗逆转录病毒方案的不同而有所差异，婴儿 cART 时间可能更长，这可能对婴儿 HIV PCR 诊断检测的安排和最终婴儿 HIV 状态的确认产生影响。
