Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA.
Clin Infect Dis. 2022 Mar 23;74(6):1047-1054. doi: 10.1093/cid/ciab586.
Younger age of antiretroviral therapy (ART) initiation is associated with smaller viral reservoirs in perinatally acquired HIV-1 infection, but there is wide variability among early-treated infants. Predictors of this variability are not fully described.
Sixty-three neonates diagnosed with HIV-1 <48 hours after birth in Johannesburg, South Africa, were started on ART as soon as possible. Fifty-nine (94%) infants received nevirapine prophylaxis from birth until ART start. Viably preserved peripheral blood mononuclear cells (PBMCs) collected at regular intervals to 48 weeks, and from mothers at enrollment, were tested using integrase-targeted, semi-nested, real-time quantitative hydrolysis probe (TaqMan) PCR assays to quantify total HIV-1 subtype C viral DNA (vDNA). Predictors were investigated using generalized estimating equation regression.
Thirty-one (49.2%) infants initiated ART <48 hours, 24 (38.1%) <14 days, and 8 (12.7%) >14 days of birth. Three-quarters were infected despite maternal antenatal ART (however, only 9.5% of women had undetectable viral load closest to delivery) and 86% were breastfed. Higher infant CD4+ T-cell percentage and viral load <100 000 copies/mL pre-ART were associated with lower vDNA in the first 48 weeks after ART start. No antenatal maternal ART and breastfeeding were also associated with lower vDNA. Older age at ART initiation had a discernible negative impact when initiated >14 days.
Among very early treated infants, higher CD4+ T-cell percentage and viral load <100 000 copies/mL pre-ART, infection occurring in the absence of maternal antenatal ART, and breastfeeding were associated with lower levels of HIV-1 DNA in the first 48 weeks of treatment. Clinical Trials Registration. clinicaltrials.gov (NCT02431975).
在围生期感染 HIV-1 的婴儿中，越早开始抗逆转录病毒治疗（ART），病毒储存库越小，但早期接受治疗的婴儿之间存在很大差异。这种差异的预测因素尚未完全描述。
南非约翰内斯堡的 63 名新生儿在出生后 48 小时内被诊断为 HIV-1，尽快开始接受 ART。59 名（94%）婴儿从出生起至开始 ART 时接受了奈韦拉平预防。定期采集存活的外周血单核细胞（PBMC），直至 48 周，并从母亲入组时采集，使用整合酶靶向、半巢式、实时定量水解探针（TaqMan）PCR 检测来定量总 HIV-1 亚型 C 病毒 DNA（vDNA）。使用广义估计方程回归来研究预测因素。
31 名（49.2%）婴儿在出生后<48 小时开始 ART，24 名（38.1%）在<14 天，8 名（12.7%）在 14 天后开始 ART。尽管母亲在产前接受了 ART，但仍有四分之三的婴儿被感染（然而，只有 9.5%的女性在分娩前的病毒载量接近检测不到），86%的婴儿接受了母乳喂养。ART 前婴儿 CD4+T 细胞百分比和病毒载量<100000 拷贝/ml 较高与 ART 开始后 48 周内 vDNA 较低有关。无产前母体 ART 和母乳喂养也与 vDNA 较低有关。ART 开始时年龄较大（>14 天）时，会产生明显的负面影响。
在非常早接受治疗的婴儿中，ART 前 CD4+T 细胞百分比和病毒载量<100000 拷贝/ml 较高、在没有母亲产前 ART 的情况下感染以及母乳喂养与治疗前 48 周内 HIV-1 DNA 水平较低有关。临床试验注册。clinicaltrials.gov（NCT02431975）。
