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Delayed Seroreversion in HIV-exposed Uninfected Infants

Chatpornvorarux, Sunsanee, MD; Maleesatharn, Alan, MBA; Rungmaitree, Supattra, MD; Wittawatmongkol, Orasri, MD; Phongsamart, Wanatpreeya, MD; Lapphra, Keswadee, MD; Kongstan, Nantaka, BN.Msc; Khumcha, Benjawan, BA; Chokephaibulkit, Kulkanya, MD

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 65–69
doi: 10.1097/INF.0000000000002196
HIV Reports
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Background: Recent studies report delayed anti-HIV antibody clearance (seroreversion) among HIV-exposed uninfected infants that may affect diagnostic practices. We evaluated the age-specific seroreversion rates in Thailand.

Methods: The medical records of HIV-exposed uninfected infants born in January 2000–December 2014 were reviewed. Anti-HIV seroreversion rates at 12, 18 and 24 months were analyzed in 3 periods according to the Thai National Guidelines of prevention of mother-to-child transmission of HIV: zidovudine with or without single dose nevirapine to all women (2000–2006), adding lamivudine plus nevirapine to zidovudine in women with CD4 count <200 cells/mm3 (2007–2009) and zidovudine plus lamivudine plus boosted lopinavir to all women (2010–2014). In 2013, the serologic test kit was changed from third- to fourth-generation (4G) assay. All the infants were formula fed.

Results: Among 736 infants, the overall seroreversion rates at 12, 18 and 24 months of age were 59.38%, 94.57% and 100%, respectively. The seroreversion rates at 12 months of age declined from 68% in 2000–2006 and 65.9% in 2007–2009, to 42.9% in 2010–2014 (P = 0.001). Seroreversion rates at 18 months of age were more than 96.5% before 2013 and decreased to 79.1% in 2013–2014 (P = 0.001) with use of 4G. Multivariate analysis identified antepartum protease inhibitors treatment and the use of 4G testing as independent factors associated with delayed seroreversion.

Conclusions: Anti-HIV seroreversion delay in HIV-exposed uninfected infants was associated with use of protease inhibitors and 4G HIV testing, complicating the interpretation to exclude perinatal HIV infection.

From the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Accepted for publication August 23, 2018.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Kulkanya Chokephaibulkit, MD, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand. E-mail: kulkanya.cho@mahidol.ac.th.

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