HIV seronegativity in children, adolescents and young adults living with perinatally acquired HIV: A cross‐sectional study in Thailand

Abstract

Introduction: Early initiation of combination antiretroviral therapy (ART) with long-term viral suppression may lead to seronegativity in grown-up children with perinatally acquired HIV (PHIV). This study aimed to determine the frequency and associated factors of seronegativity in Thai children, adolescents and young adults with PHIV. Methods: A cross-sectional HIV serological study was performed in children, adolescents and young adults two years or older who were receiving ART with undetectable HIV-RNA for at least one year from August 2018 to August 2019. Medical records were extracted for multivariate analysis of independent factors for seronegativity. Results and discussion: Of 110 patients, 50 male, median (range) age was 18.4 (4.8 to 26.6) years, 8 (7.3%) were seronegative, and 1 (0.9 %) was inconclusive. The seronegative group had a younger median (range) age at ART initiation: 3.0 (1.0 to 12.0) versus 40.0 (2.0 to 207.0) months, p = 0.045; and shorter median (range) duration from ART initiation to viral suppression: 16.8 (7.2 to 42.0) versus 55.2 (6.0 to 214.8) months, p = 0.036. Multivariate analysis identified younger age at ART initiation (aOR 0.69, 95% CI 0.49 to 0.98, p = 0.038) and shorter time to viral suppression after ART initiation (aOR 0.94, 95% CI 0.89 to 0.99, p = 0.019) as independent factors associated with HIV seronegativity. Of the infants who initiated ART < 3 and between three and six months of age, 50% and 26.7% became seronegative respectively. Conclusions: HIV seronegativity was observed in children and adolescents with PHIV who initiated ART early in infancy and had rapid and sustained virological response. Awareness of this phenomenon will help avoid inappropriate treatment interruption on the basis of negative antibody testing.

Influence of Combination Antiretroviral Therapy on HIV-1 Serological Responses and Their Implications: A Systematic Review and Meta-Analysis

“…Our searches returned a total of 2,321 records from 28 studies ( 4 , 14 – 29 , 31 – 40 , 75 ). The median sample size is 41 (interquartile range (IQR): 16–101).…”

“…Eleven studies (N = 565) were conducted in the United States, 5 (N = 376) in Thailand, 3 (N = 369) in South Africa, 2 (N = 75) in Italy, and one each in Zimbabwe (N = 129), Mali (N = 97), China (N = 73), Canada (N = 69), France (N = 44), Spain (N = 14), and the United Kingdom (N = 10). There were 20 surveys with a median sample size of 29 (IQR: 13–107) to evaluate the serostatus in cART-treated vertically infected children of ≥16 months old ( 4 , 14 – 29 , 31 – 33 ), while the frequency of seronegativity in the cART-treated adult population was reported in 8 investigations with a median sample size of 80 (IQR: 36–101) ( 34 – 40 , 75 ).…”

“…Among the 20 selected studies that focus on cART-treated children ( Table 1 ), the frequency of seronegativity was reported in 11 studies in which early-treated children were included with a median age of 2.2 months (IQR: 1.7–2.7, N = 583) when cART started ( 4 , 14 – 16 , 20 – 22 , 26 , 29 , 32 , 33 ) and in 4 studies that deferred-treated children were included with a median age of 55.7 months (IQR: 37.4–86.4, N = 587) ( 18 , 23 – 25 ). In addition, 5 studies included both early-treated and deferred-treated children and separately reported the frequency of seronegativity in the two groups ( 17 , 19 , 27 , 28 , 31 ). Of the 8 studies that investigated the serostatus in cART-treated adults ( Table 2 ), 4 ( 34 , 36 , 38 , 75 ) and 3 ( 35 , 39 , 40 ) studies recruited early-cART (N = 366) and deferred-cART-treated patients (N = 275), respectively.…”