简报：2010-2016 年南非早期婴儿诊断计划中，基线病毒载量下降和不一致的 HIV-1 确认结果增加。

Brief Report: Declining Baseline Viremia and Escalating Discordant HIV-1 Confirmatory Results Within South Africa's Early Infant Diagnosis Program, 2010-2016.

机构信息

Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.

Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

出版信息

J Acquir Immune Defic Syndr. 2018 Feb 1;77(2):212-216. doi: 10.1097/QAI.0000000000001581.

DOI:10.1097/QAI.0000000000001581

PMID:29084045

Abstract

OBJECTIVE

To describe baseline HIV-1 RNA viral load (VL) trends within South Africa's Early Infant Diagnosis program 2010-2016, with reference to prevention of mother-to-child transmission guidelines.

METHODS

HIV-1 total nucleic acid polymerase chain reaction (TNA PCR) and RNA VL data from 2010 to 2016 were extracted from the South African National Health Laboratory Service's central data repository. Infants with a positive TNA PCR and subsequent baseline RNA VL taken at age <7 months were included. Descriptive statistics were performed for quantified and lower-than-quantification limit (LQL) results per annum and age in months. Trend analyses were performed using log likelihood ratio tests. Multivariable linear regression was used to model the relationship between RNA VL and predictor variables, whereas logistic regression was used to identify predictors associated with LQL RNA VL results.

RESULTS

Among 13,606 infants with a positive HIV-1 TNA PCR linked to a baseline RNA VL, median age of first PCR was 57 days and VL was 98 days. Thirteen thousand one hundred ninety-five (97.0%) infants had a quantified VL and 411 (3.0%) had an LQL result. A significant decline in median VL was observed between 2010 and 2016, from 6.3 log10 (interquartile range: 5.6-6.8) to 5.6 log10 (interquartile range: 4.2-6.5) RNA copies per milliliter, after controlling for age (P < 0.001), with younger age associated with lower VL (P < 0.001). The proportion of infants with a baseline VL <4 Log10 RNA copies per milliliter increased from 5.4% to 21.8%. Subsequent to prevention of mother-to-child transmission Option B implementation in 2013, the proportion of infants with an LQL baseline VL increased from 1.5% to 6.1% (P < 0.001).

CONCLUSIONS

Between 2010 and 2016, a significant decline in baseline viremia within South Africa's Early Infant Diagnosis program was observed, with loss of detectability among some HIV-infected infants.

摘要

目的

描述 2010-2016 年南非早期婴儿诊断计划中 HIV-1 病毒载量（VL）的基线趋势，并参考母婴传播预防指南。

方法

从南非国家卫生实验室服务中心的数据存储库中提取 2010 年至 2016 年 HIV-1 总核酸聚合酶链反应（TNA PCR）和 RNA VL 数据。纳入 TNA PCR 阳性且年龄<7 个月时进行基线 RNA VL 检测的婴儿。对每年和每月的定量和低于定量限（LQL）结果进行描述性统计。采用对数似然比检验进行趋势分析。采用多元线性回归模型分析 RNA VL 与预测变量之间的关系，采用逻辑回归分析与 LQL RNA VL 结果相关的预测因素。

结果

在 13606 例 HIV-1 TNA PCR 阳性且与基线 RNA VL 相关的婴儿中，首次 PCR 的中位年龄为 57 天，VL 为 98 天。13195 例（97.0%）婴儿的 VL 可定量，411 例（3.0%）婴儿的 VL 低于定量限。在控制年龄后（P<0.001），2010 年至 2016 年间，中位 VL 从 6.3 log10（四分位距：5.6-6.8）显著下降至 5.6 log10（四分位距：4.2-6.5）拷贝/毫升，且年龄越小 VL 越低（P<0.001）。基线 VL<4 Log10 拷贝/毫升的婴儿比例从 5.4%增加至 21.8%。2013 年实施母婴传播预防方案 B 后，基线 VL 低于定量限的婴儿比例从 1.5%增加至 6.1%（P<0.001）。