From the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pediatr Infect Dis J. 2019 Jan;38(1):65-69. doi: 10.1097/INF.0000000000002196.
Recent studies report delayed anti-HIV antibody clearance (seroreversion) among HIV-exposed uninfected infants that may affect diagnostic practices. We evaluated the age-specific seroreversion rates in Thailand.
The medical records of HIV-exposed uninfected infants born in January 2000-December 2014 were reviewed. Anti-HIV seroreversion rates at 12, 18 and 24 months were analyzed in 3 periods according to the Thai National Guidelines of prevention of mother-to-child transmission of HIV: zidovudine with or without single dose nevirapine to all women (2000-2006), adding lamivudine plus nevirapine to zidovudine in women with CD4 count <200 cells/mm (2007-2009) and zidovudine plus lamivudine plus boosted lopinavir to all women (2010-2014). In 2013, the serologic test kit was changed from third- to fourth-generation (4G) assay. All the infants were formula fed.
Among 736 infants, the overall seroreversion rates at 12, 18 and 24 months of age were 59.38%, 94.57% and 100%, respectively. The seroreversion rates at 12 months of age declined from 68% in 2000-2006 and 65.9% in 2007-2009, to 42.9% in 2010-2014 (P = 0.001). Seroreversion rates at 18 months of age were more than 96.5% before 2013 and decreased to 79.1% in 2013-2014 (P = 0.001) with use of 4G. Multivariate analysis identified antepartum protease inhibitors treatment and the use of 4G testing as independent factors associated with delayed seroreversion.
Anti-HIV seroreversion delay in HIV-exposed uninfected infants was associated with use of protease inhibitors and 4G HIV testing, complicating the interpretation to exclude perinatal HIV infection.
最近的研究报告称，HIV 暴露但未感染的婴儿的抗 HIV 抗体清除（血清学转换）延迟，这可能会影响诊断实践。我们评估了泰国的特定年龄血清学转换率。
回顾了 2000 年 1 月至 2014 年 12 月期间出生的 HIV 暴露但未感染的婴儿的病历。根据泰国预防母婴传播 HIV 的国家指南，在 3 个时期分析了 12、18 和 24 个月时的抗 HIV 血清学转换率：齐多夫定加或不加单剂量奈韦拉平用于所有女性（2000-2006 年）、将拉米夫定加奈韦拉平添加到 CD4 计数<200 个细胞/mm 的女性的齐多夫定中（2007-2009 年）和齐多夫定加拉米夫定加洛匹那韦增效剂用于所有女性（2010-2014 年）。2013 年，血清学检测试剂盒从第三代（3G）检测改为第四代（4G）检测。所有婴儿均配方奶喂养。
在 736 名婴儿中，12、18 和 24 个月时的总体血清学转换率分别为 59.38%、94.57%和 100%。12 个月时的血清学转换率从 2000-2006 年的 68%和 2007-2009 年的 65.9%下降至 2010-2014 年的 42.9%（P=0.001）。2013 年之前，18 个月时的血清学转换率超过 96.5%，但在 2013-2014 年使用 4G 时降至 79.1%（P=0.001）。多变量分析确定产前蛋白酶抑制剂治疗和使用 4G 检测是与血清学转换延迟相关的独立因素。
HIV 暴露但未感染婴儿的抗 HIV 血清学转换延迟与蛋白酶抑制剂和 4G HIV 检测的使用有关，这使得排除围产期 HIV 感染的解释变得复杂。
