Viral Suppression in Children on ART Identified Via Quantitative HIV Antibody Levels

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Investigators report that quantitative HIV-1 specific antibody levels may be useful for screening children ART for viral suppression or for residual cell-associated HIV-1 DNA levels.
Investigators report that quantitative HIV-1 specific antibody levels may be useful for screening children ART for viral suppression or for residual cell-associated HIV-1 DNA levels.

For children receiving antiretroviral therapy (ART), HIV-1-specific antibody levels can be useful markers for identifying those with viral suppression or low residual cell-associated HIV-1 DNA levels, according to research published in Clinical Infectious Diseases.

Current methods for quantifying plasma HIV-1 RNA and peripheral blood mononuclear cell-associated HIV-1 DNA in children receiving ART can be costly and present logistical challenges, especially in settings with limited resources. This study evaluated the use of quantitative HIV-1 antibody levels to HIV-1 proteins as a screening method for virologic suppression and residual peripheral blood mononuclear cells in 46 HIV-1-infected children who were stratified by the timing of ART initiation (early therapy: age <3 months; late therapy, age >3 months-2 years) and as either virologic responders or nonresponders.

An additional 20 children who were uninfected but were born to HIV-1 infected mothers (seroreverters) were also included in the analysis. The study authors also quantified antibody levels to HIV-1 envelope (gp160, gp41), gag (capsid, p24; matrix, p17), reverse transcriptase (p66/51), and integrase (p31).

In the early therapy responders group, the rates of HIV-1 antibody decline were similar to those in the seroreverters cohort for all antibody specificities, with the exception of p17 (P =.01), whereas antibody decline rates in the late therapy responder group and the nonresponder group were significantly slower vs the seroreverters group for all antibody specificities. Antibody levels to p31 and p17 after 1 year were significantly associated with HIV-1 RNA levels (P <.001), whereas antibody levels to gp160 (P <.001) and gp41 (P <.001) were similarly associated with cell-associated HIV-1 DNA levels.

"Our data suggest that antibodies detected after age 12-13 months are largely generated in response to viral replication and antigen production associated with infection," wrote the study authors.

Reference

McManus M, Henderson J, Gautam A , et al. Quantitative HIV-1 antibodies correlate with plasma HIV-1 RNA and cell-associated DNA levels in children on ART [published online September 5, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy753

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