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Delayed anti-HIV antibody clearance in infants exposed to HIV may complicate diagnosis. Protease inhibitor use and fourth-generation (4G) testing are linked to this delayed seroreversion, affecting interpretation of infant HIV status.

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Area of Science:

  • Immunology
  • Virology
  • Pediatrics

Background:

  • Delayed anti-HIV antibody clearance (seroreversion) is increasingly reported in HIV-exposed uninfected infants.
  • This phenomenon can complicate diagnostic practices for perinatal HIV infection.
  • This study evaluated age-specific seroreversion rates in Thailand.

Purpose of the Study:

  • To analyze age-specific anti-HIV seroreversion rates in HIV-exposed uninfected infants in Thailand.
  • To identify factors associated with delayed seroreversion.
  • To understand the impact of evolving prevention of mother-to-child HIV transmission (PMTCT) guidelines and diagnostic assays on seroreversion.

Main Methods:

  • Retrospective review of medical records of HIV-exposed uninfected infants born between 2000 and 2014.
  • Analysis of anti-HIV seroreversion rates at 12, 18, and 24 months across three PMTCT guideline periods.
  • Assessment of the impact of a switch from third- to fourth-generation (4G) HIV assay in 2013.

Main Results:

  • Overall seroreversion rates at 12, 18, and 24 months were 59.38%, 94.57%, and 100%, respectively.
  • Seroreversion rates at 12 months decreased significantly in the latest PMTCT period (42.9% vs. ~67%).
  • Use of 4G testing was associated with decreased seroreversion rates at 18 months (79.1% vs. >96.5% before 2013).
  • Antepartum protease inhibitor treatment and 4G testing were independently associated with delayed seroreversion.

Conclusions:

  • Delayed anti-HIV seroreversion in HIV-exposed uninfected infants is influenced by maternal protease inhibitor treatment and the use of 4G HIV testing.
  • These factors complicate the interpretation of infant HIV test results, making it harder to exclude perinatal HIV infection.
  • Further research is needed to refine diagnostic strategies for this population.