p38 MAPK

All children met clinical or CD4 criteria to initiate ART which included World Health Organization stage III or IV disease, CD4 percentage <25 if younger than 12 months or <20 if older than 12 months, or recurrent (> 2/year) or prolonged (> 4 weeks) hospitalization for HIV-related complications

All children met clinical or CD4 criteria to initiate ART which included World Health Organization stage III or IV disease, CD4 percentage <25 if younger than 12 months or <20 if older than 12 months, or recurrent (> 2/year) or prolonged (> 4 weeks) hospitalization for HIV-related complications. 2 or 3 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 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. Introduction HIV antibody tests are considered to be diagnostic in adults and older children but cannot be used in infancy for diagnosis. This is because of transplacental passage of maternal HIV antibodies which may persist in the Octreotide young child at detectable levels for up to 18 months or longer.1 Before this age, Octreotide these tests cannot distinguish the child’s from the mother’s HIV infection. After this age, HIV antibody tests are used routinely for diagnosis in children, in the same way that they are used in adults, with the typical expectation that antibody status does not revert to negative after a positive result.2 Thus the reports of virologically-confirmed, HIV-infected children suppressed on antiretroviral therapy (ART) who have negative HIV antibody tests are intriguing.3 An early U.S. report described 16/17 infected infants initiating ART at 15 days to 3 months of age becoming antibody negative by 16 months.4 Five of 12 early-treated children in Belgium and 4 of 6 in Italy have also been reported to be persistently antibody negative once suppressed.5C7 The so-called Mississippi baby who started ART within 30 hours of birth and who maintained viral control for more than two years after ART was stopped also had negative HIV antibody results thus reviving interest in this issue.8 The recent case reports of early-treated children have also reported negative HIV antibody results during suppressive ART.9C11 In the clinical setting, a negative HIV antibody test in an ART-treated child raises a variety of concerns for clinicians and parents. Virologic and diagnostic testing history would need to be reviewed to determine whether the child was initially misdiagnosed. If indeed the child is confirmed to be HIV-infected, then clinicians would need to explain Octreotide to parents the significance of the negative antibody result. This would most likely include Octreotide clarification that the antibody test result does not mean that the child is no longer HIV-infected and emphasis on the continuation of the child’s ART. There are concerning anecdotal reports of health Rabbit Polyclonal to TF2H2 care workers stopping ART in children testing antibody negative based on mistaken assumptions.12 Thus, better understanding of the frequency of this phenomenon in clinical populations, particularly in sub-Saharan Africa, is important to ensure appropriate clinical management for HIV-infected children. Existing published reports provide limited information about the frequency of HIV antibody negativity in ART-treated children and are largely based on small numbers of highly-select children from academic centers in North America and Europe. Here we describe the frequency and predictors of testing HIV antibody negative in a well-characterized cohort of HIV-infected, ART-treated children in Johannesburg, South Africa. Methods We selected samples in two rounds from HIV-infected children who had started therapy before two years of age followed as part of two sequential clinical trials at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa.13,14 These trials were approved by the Institutional Review Boards of Columbia University and the University of the Witwatersrand. The child’s guardian provided signed informed consent. All children had been diagnosed as HIV-infected on at least one standard qualitative HIV-1 PCR confirmed on at least one quantitative viral load test..