Puthanakit Thanyawee, Ananworanich Jintanat, Akapirat Siriwat, Pattanachaiwit Supanit, Ubolyam Sasiwimol, Assawadarachai Vatcharain, Sawangsinth Panadda, Jupimai Thidarat, Anugulruengkitt Suvaporn, Tawan Monta, Kosalaraksa Pope, Borkird Thitiporn, Suntarattiwong Piyarat, Kanjanavanit Suparat, de Souza Mark S
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
J Acquir Immune Defic Syndr. 2020 Mar 1;83(3):260-266. doi: 10.1097/QAI.0000000000002254.
Previous studies have shown low frequencies of seroreactivity to HIV diagnostic assays for infected infants treated with antiretroviral therapy (ART) early in infection.
Fifty-eight HIV-infected infants treated with ART at a median age of 1.9 months (range: 0.2-5.4) for up to 4 years of life were assessed for seroreactivity to 4 routinely used HIV clinical immunoassays (IA): Second-generation (2ndG) IA and 2 rapid diagnostic tests (RDT), based on third-generation principles, measuring antibody only and a fourth-generation (4thG) antigen/antibody IA. HIV Western blot assay was also performed to assess HIV-specific antibodies.
The 2ndG IA demonstrated the highest frequency of seroreactivity in children (69%) followed by the 4thG IA (40%) and the RDT (26%) after one year of ART. Infants initiating ART during ages 3-6 months (N = 15) showed a greater frequency (range: 53%-93%) and breadth (median and range: 3 [1-4]) of reactivity across the assays compared with those treated within 3 months (N = 43):16%-61% and breadth (1 [0-4]). The 4thG IA showed significantly reduced reactivity relative to the 2ndG IA at one (P = 0.016) and 3 (P = 0.004) years of ART. Western blot profiles following 3 years of ART showed the highest frequency of reactivity to HIV Gag p24 (76%) and lowest reactivity to Env gp120 and gp41, with only 24% of children confirmed positive by the assay.
These results suggest that the use of 4thG IA and RDT test combination algorithms with limited HIV antigen breadth may not be adequate for diagnosis of HIV-infected children following early treatment.
先前的研究表明，对于感染早期即接受抗逆转录病毒治疗（ART）的感染婴儿，HIV诊断检测的血清反应性频率较低。
对58名接受ART治疗的HIV感染婴儿进行评估，这些婴儿的中位年龄为1.9个月（范围：0.2 - 5.4个月），随访至4岁，检测其对4种常规使用的HIV临床免疫检测（IA）的血清反应性：第二代（2ndG）IA和2种基于第三代原理的快速诊断检测（RDT），后者仅检测抗体，以及第四代（4thG）抗原/抗体IA。还进行了HIV免疫印迹试验以评估HIV特异性抗体。
接受ART治疗1年后，第二代IA在儿童中的血清反应性频率最高（69%），其次是第四代IA（40%）和RDT（26%）。与3个月内接受治疗的婴儿（N = 43）相比，3 - 6个月开始接受ART治疗的婴儿（N = 15）在各检测中的反应性频率更高（范围：53% - 93%）且广度更大（中位数及范围：3 [1 - 4]）：16% - 61%及广度（1 [0 - 4]）。在接受ART治疗1年（P = 0.016）和3年（P = 0.004）时，第四代IA相对于第二代IA的反应性显著降低。接受ART治疗3年后的免疫印迹图谱显示，对HIV Gag p24的反应性频率最高（76%），对Env gp120和gp41的反应性最低，只有24%的儿童通过该检测确诊为阳性。
这些结果表明，使用HIV抗原广度有限的第四代IA和RDT检测组合算法可能不足以诊断早期治疗后的HIV感染儿童。
