HIV diagnostic challenges in breast-fed infants of mothers on antiretroviral therapy

dc.contributor.authorStrehlau, Renate
dc.contributor.authorPaximadis, Maria
dc.contributor.authorPatel, Faeezah
dc.contributor.authorBurke, Megan
dc.contributor.authorTechnau, Karl-Gunter
dc.contributor.authorShiau, Stephanie
dc.contributor.authorAbrams, Elaine J.
dc.contributor.authorSherman, Gayle G.
dc.contributor.authorHunt, Gillian
dc.contributor.authorLedwaba, Johanna
dc.contributor.authorMazanderani, Ahmad Haeri
dc.contributor.authorTiemessen, Caroline T.
dc.contributor.authorKuhn, Louise
dc.date.accessioned2020-04-23T05:40:57Z
dc.date.issued2019-09
dc.description.abstractBACKGROUND : 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. METHODS : 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. 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. CONCLUSION : 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.en_ZA
dc.description.departmentMedical Virologyen_ZA
dc.description.embargo2020-09-01
dc.description.librarianhj2020en_ZA
dc.description.sponsorshipThe Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institute of Allergy and Infectious Disease, National Institutes of Health (U01HD080441) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa.en_ZA
dc.description.urihttp://journals.lww.com/aidsonlineen_ZA
dc.identifier.citationStrehlau, R., Paximadis, M., Patel, F. et al. 2019, 'HIV diagnostic challenges in breast-fed infants of mothers on antiretroviral therapy', AIDS, vol. 33, no. 11, pp. 1751-1756.en_ZA
dc.identifier.issn0269-9370 (print)
dc.identifier.issn1473-5571 (online)
dc.identifier.other10.1097/QAD.0000000000002276
dc.identifier.urihttp://hdl.handle.net/2263/74354
dc.language.isoenen_ZA
dc.publisherWolters Kluwer Healthen_ZA
dc.rights© 2019 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in AIDS, vol. 33, no. 11, pp. 1751-1756, 2019, doi : 10.1097/QAD.0000000000002276.en_ZA
dc.subjectAntiretroviral therapy (ART)en_ZA
dc.subjectHuman immunodeficiency virus (HIV)en_ZA
dc.subjectHIV-infected infantsen_ZA
dc.subjectNucleic acid amplification tests (NAAT)en_ZA
dc.titleHIV diagnostic challenges in breast-fed infants of mothers on antiretroviral therapyen_ZA
dc.typePostprint Articleen_ZA

Files

Original bundle

Now showing 1 - 2 of 2
Loading...
Thumbnail Image
Name:
Strehlau_HIV_2019.pdf
Size:
387.58 KB
Format:
Adobe Portable Document Format
Description:
Postprint Article
Loading...
Thumbnail Image
Name:
Strehlau_HIVSuppl_2019.pdf
Size:
632.59 KB
Format:
Adobe Portable Document Format
Description:
Supplementary Material

License bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
license.txt
Size:
1.75 KB
Format:
Item-specific license agreed upon to submission
Description: