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Amplifying and Quantifying HIV-1 RNA in HIV Infected Individuals with Viral Loads Below the Limit of Detection by Standard Clinical Assays
Published on: September 26, 2011
Long-term pattern of HIV-1 RNA load in perinatally infected children
L Navér1, A Ehrnst, E Belfrage
1Department of Paediatrics, Huddinge University Hospital, Sweden.
Insights
The viral load in vertically HIV-1-infected children peaks early and fluctuates significantly. HIV-1 RNA levels are challenging to use for predicting disease progression in children.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Vertical transmission of Human Immunodeficiency Virus type 1 (HIV-1) results in lifelong infection in children.
- Understanding the natural history of HIV-1 RNA load is crucial for managing pediatric HIV.
- Previous studies have not fully characterized the longitudinal viral dynamics in vertically infected children.
Purpose of the Study:
- To describe the natural history and longitudinal changes in HIV-1 RNA viral load in vertically HIV-1-infected children.
- To investigate the patterns of viral load fluctuation from birth through childhood.
- To assess the utility of HIV-1 RNA levels for predicting disease progression in pediatric HIV.
Main Methods:
- Analysis of 156 plasma or serum samples from 32 vertically HIV-1-infected children.
- Detection of HIV-1 RNA using the NASBA technique.
- Prospective follow-up from birth for 21 children and inclusion of 11 children aged 7-89 months.
Main Results:
- HIV-1 RNA viral load peaked between 1.5-3 months of age.
- A quadratic model indicated a decrease in viral load up to age 8, followed by an increase (p(age)=0.002, p(age2)=0.008).
- Significant individual variation in viral load was observed, with levels remaining high and fluctuating throughout childhood, irrespective of symptoms.
Conclusions:
- HIV-1 RNA viral load in vertically infected children exhibits a distinct pattern with early peaks and significant long-term fluctuations.
- The high variability and fluctuating nature of pediatric HIV-1 RNA levels limit their use as a sole predictor of disease progression or for guiding therapy initiation.
- Further research is needed to establish reliable markers for monitoring pediatric HIV disease in the context of viral load dynamics.
Abstract:
The objective of this study was to describe the natural history of HIV-1 RNA load in vertically HIV-1-infected children. HIV-1 RNA in 156 plasma or serum samples (1-14, median 4 from each child) from 32 vertically HIV-1-infected children was detected with the NASBA technique (Organon Teknika, The Netherlands). Twenty-one children were prospectively followed from birth, and 11 were identified and included at the age of 7-89 (median 61) months. The highest numbers of HIV-1 RNA copies were seen at 1.5-3 months of age. A quadratic curve model showed a reduction of HIV-1 RNA with increasing age up to approximately 8 years, and thereafter increasing numbers, p(age) = 0.002, p(age2) = 0.008. This pattern was not typical for individual children in whom a great variation in HIV-1 RNA numbers was seen over time. The interval from birth to the first HIV-1 RNA peak ranged from 1.5 months to more than 2 years. The HIV-1 RNA levels remained relatively high and fluctuating over the years in symptomatic as well as in long-term asymptomatic children. This makes HIV-1 RNA determination in children more difficult to use than in adults, as the only tool for prediction of disease progression and for initiation of therapy.
