Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

  • Kuhn L
  • Schramm D
  • Shiau S
 et al. 
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Background: Negative results on standard HIV antibody tests have been described among HIV-infected children suppressed on antiretroviral therapy (ART) started early in life. Here, we describe the frequency and predictors of this phenomenon in a well characterized cohort of treated children.Methods: We selected samples from 103 HIV-infected children who started ART 14 months of age or less and from 122 children who started 6 months of age or less followed as part of two sequential clinical trials in Johannesburg, South Africa. Children had attained viral suppression on ART and had received ART for between 3 and 6.4 years (mean 4.3 years) when tested for HIV antibody using a standard ELISA (Genescreen HIV1/2 version 2; Bio-rad).Results: Only children 6 months of age or less when ART was started had negative antibody results when tested after suppression on ART several years later. Negative or low-positive antibody results were observed in 40.0, 37.0 and 27.8% of children starting ART less than 2 months of age, or starting during month 2 or 3, respectively. This dropped to 5.9, 3.5 and 5.3% if ART was started during month 4, 5 and 6, respectively. Higher CD4(+) percentage prior to ART initiation and no recorded intermittent viremia also predicted negative antibody results.Conclusion: Testing negative on standard HIV antibody tests occurs fairly commonly among HIV-infected children who started ART 3 months of age or less and are virally suppressed. It would be prudent in clinical practice to avoid HIV antibody tests among virally suppressed, early-treated children to prevent unnecessary confusion. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

Author-supplied keywords

  • Child diagnosis
  • Early infant diagnosis
  • HIV antibody
  • Low resource setting
  • Paediatric management
  • Paediatric treatment

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  • Louise Kuhn

  • Diana B. Schramm

  • Stephanie Shiau

  • Renate Strehlau

  • Francoise Pinillos

  • Karl Technau

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