Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Int AIDS Soc. 2020 Sep;23(9):e25614. doi: 10.1002/jia2.25614.
Early initiation of combination antiretroviral therapy (ART) with long-term viral suppression may lead to seronegativity in grown-up children with perinatally acquired HIV (PHIV). This study aimed to determine the frequency and associated factors of seronegativity in Thai children, adolescents and young adults with PHIV.
A cross-sectional HIV serological study was performed in children, adolescents and young adults two years or older who were receiving ART with undetectable HIV-RNA for at least one year from August 2018 to August 2019. Medical records were extracted for multivariate analysis of independent factors for seronegativity.
Of 110 patients, 50 male, median (range) age was 18.4 (4.8 to 26.6) years, 8 (7.3%) were seronegative, and 1 (0.9 %) was inconclusive. The seronegative group had a younger median (range) age at ART initiation: 3.0 (1.0 to 12.0) versus 40.0 (2.0 to 207.0) months, p = 0.045; and shorter median (range) duration from ART initiation to viral suppression: 16.8 (7.2 to 42.0) versus 55.2 (6.0 to 214.8) months, p = 0.036. Multivariate analysis identified younger age at ART initiation (aOR 0.69, 95% CI 0.49 to 0.98, p = 0.038) and shorter time to viral suppression after ART initiation (aOR 0.94, 95% CI 0.89 to 0.99, p = 0.019) as independent factors associated with HIV seronegativity. Of the infants who initiated ART < 3 and between three and six months of age, 50% and 26.7% became seronegative respectively.
HIV seronegativity was observed in children and adolescents with PHIV who initiated ART early in infancy and had rapid and sustained virological response. Awareness of this phenomenon will help avoid inappropriate treatment interruption on the basis of negative antibody testing.
早期开始联合抗逆转录病毒治疗（ART）并长期病毒抑制，可能会导致母婴传播获得 HIV（PHIV）的成年儿童转为血清阴性。本研究旨在确定泰国 PHIV 儿童、青少年和年轻成人中血清阴性的频率和相关因素。
2018 年 8 月至 2019 年 8 月，对接受 ART 治疗至少一年且 HIV-RNA 不可检测的两岁或以上儿童、青少年和年轻成人进行了 HIV 血清学的横断面研究。提取病历资料进行多变量分析，以确定血清学阴性的独立因素。
在 110 例患者中，50 例为男性，中位（范围）年龄为 18.4（4.8 至 26.6）岁，8 例（7.3%）为血清阴性，1 例（0.9%）结果不确定。血清学阴性组的 ART 开始年龄更小：3.0（1.0 至 12.0）与 40.0（2.0 至 207.0）个月，p=0.045；ART 开始至病毒抑制的中位（范围）时间更短：16.8（7.2 至 42.0）与 55.2（6.0 至 214.8）个月，p=0.036。多变量分析确定了 ART 开始年龄较小（aOR 0.69，95%CI 0.49 至 0.98，p=0.038）和 ART 开始后病毒抑制更快（aOR 0.94，95%CI 0.89 至 0.99，p=0.019）是与 HIV 血清学阴性相关的独立因素。在<3 个月和 3 至 6 个月开始 ART 的婴儿中，分别有 50%和 26.7%转为血清学阴性。
在婴儿期早期开始 ART 且具有快速和持续病毒学反应的 PHIV 儿童和青少年中观察到 HIV 血清学阴性。对这种现象的认识将有助于避免基于抗体检测阴性而不当中断治疗。
