Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital.
Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services.
AIDS. 2019 Sep 1;33(11):1751-1756. doi: 10.1097/QAD.0000000000002276.
Prompt initiation of antiretroviral therapy (ART) for HIV-infected infants is strongly recommended but diagnostic confirmation is important as committing children to life-long ART carries serious health and social implications.
Two HIV-exposed infants in Johannesburg, South Africa were identified presenting with unusual trajectories of diagnostic nucleic acid amplification tests (NAAT) and viral load results.
Case 1 had repeat indeterminate NAAT results during the first 3 weeks of life; repeat testing thereafter was negative with undetectable viral load including after daily nevirapine prophylaxis ended. ART was not initiated at this time. Case 2 had a single positive NAAT result at 1 month of age that prompted initiation of ART. Subsequent results were negative and ART was discontinued. Repeat negative NAAT with viral load below the limit of quantification or undetectable continued to be obtained. Shortly after and around weaning, positive NAAT results with high viral load (7.1 and 6.03 log10 copies/ml for Cases 1 and 2, respectively) were observed in both children. Both mothers were treated with tenofovir, emtricitabine and efavirenz during breastfeeding. Testing with ultrasensitive assays on early samples conclusively revealed HIV-1 proviral DNA in Case 1. Testing with ultrasensitive assays after the early period but prior to weaning did not detect HIV in either infant.
We hypothesize that breast milk from the mothers of these two rare cases had HIV-specific or nonspecific factors that led to the undetectable results in already infected infants until breastfeeding ended. Our results raise the importance of repeat testing of HIV-exposed breast-fed infants after complete cessation of all breastfeeding.
强烈建议为感染 HIV 的婴儿及时启动抗逆转录病毒疗法（ART），但诊断确证非常重要，因为让儿童终身接受 ART 治疗会带来严重的健康和社会影响。
在南非约翰内斯堡发现了两名表现出不寻常诊断核酸扩增试验（NAAT）和病毒载量结果轨迹的 HIV 暴露婴儿。
病例 1 在生命的前 3 周内重复出现不确定的 NAAT 结果；此后重复检测结果为阴性，病毒载量无法检测，包括在每日奈韦拉平预防结束后。此时并未启动 ART。病例 2 在 1 个月大时单次出现阳性 NAAT 结果，促使启动了 ART。随后的结果为阴性，并停止了 ART。重复的阴性 NAAT 和低于定量下限或无法检测到的病毒载量仍持续存在。在这两个孩子中，不久之后和断奶前后，均观察到具有高病毒载量的阳性 NAAT 结果（病例 1 和 2 的病毒载量分别为 7.1 和 6.03 log10 拷贝/ml）。两位母亲在哺乳期均接受了替诺福韦、恩曲他滨和依法韦仑治疗。早期样本的超灵敏检测结果明确显示病例 1 存在 HIV-1 前病毒 DNA。在早期阶段但在断奶之前进行的超灵敏检测并未在任何婴儿中检测到 HIV。
我们假设这两个罕见病例的母亲的母乳中存在 HIV 特异性或非特异性因素，导致已经感染的婴儿在停止母乳喂养之前无法检测到结果。我们的结果表明，在完全停止所有母乳喂养后，需要对 HIV 暴露的母乳喂养婴儿进行重复检测。
