HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
J Infect Dis. 2021 Dec 1;224(11):1925-1934. doi: 10.1093/infdis/jiab223.
Early HIV diagnosis allows combination antiretroviral therapy (cART) initiation in the first days of life following in utero (IU) infection. The impact of early cART initiation on infant viral reservoir size in the setting of high-frequency cART nonadherence is unknown.
Peripheral blood total HIV DNA from 164 early treated (day 0-21 of life) IU HIV-infected South African infants was measured using droplet digital PCR at birth and following suppressive cART. We evaluated the impact of cART initiation timing on HIV reservoir size and decay, and on the risk of subsequent plasma viremia in cART-suppressed infants.
Baseline HIV DNA (median 2.8 log10 copies/million peripheral blood mononuclear cells, range 0.7-4.8) did not correlate with age at cART initiation (0-21 days) but instead with maternal antenatal cART use. In 98 infants with plasma viral suppression on cART, HIV DNA half-life was 28 days. However, the probability of maintenance of plasma aviremia was low (0.46 at 12 months) and not influenced by HIV DNA load. Unexpectedly, longer time to viral suppression was associated with protection against subsequent viral rebound.
With effective prophylaxis against mother-to-child transmission, cART initiation timing in the first 3 weeks of life is not critical to reservoir size.
早期诊断 HIV 可使感染后在宫内（IU）感染的婴儿在生命的最初几天内开始联合抗逆转录病毒治疗（cART）。在频繁不依从 cART 的情况下，早期开始 cART 对婴儿病毒储存库大小的影响尚不清楚。
采用液滴数字 PCR 法，在出生时和抑制性 cART 后，检测 164 例早期治疗（生命第 0-21 天）IU HIV 感染南非婴儿的外周血总 HIV DNA。我们评估了 cART 起始时间对 HIV 储存库大小和衰减的影响，以及对 cART 抑制婴儿随后血浆病毒血症的风险的影响。
基线 HIV DNA（中位数 2.8 log10 拷贝/百万外周血单核细胞，范围 0.7-4.8）与 cART 起始年龄（0-21 天）无关，而与母体产前 cART 使用有关。在 98 例 cART 血浆病毒抑制的婴儿中，HIV DNA 半衰期为 28 天。然而，维持血浆无病毒血症的概率较低（12 个月时为 0.46），且不受 HIV DNA 载量的影响。出乎意料的是，更长的病毒抑制时间与随后的病毒反弹保护有关。
在有效预防母婴传播的情况下，生命的前 3 周内开始 cART 对储存库大小并不重要。
