HIV 暴露而未感染婴儿的血清学反应延迟消退。

Delayed Seroreversion in HIV-exposed Uninfected Infants.

机构信息

From the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Pediatr Infect Dis J. 2019 Jan;38(1):65-69. doi: 10.1097/INF.0000000000002196.

DOI:10.1097/INF.0000000000002196

PMID:30239474

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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。