Related Experiment Videos
Shortened survival in infants vertically infected with human immunodeficiency virus with elevated p24 antigenemia
N Z Arlievsky1, H Pollack, M Rigaud
1Department of Pediatrics, New York University Medical Center, NY 10016, USA.
Insights
Elevated p24 antigen levels in infants with vertically acquired HIV-1 infection during the first six months of life predict shorter survival. Early detection of high p24 antigenemia can inform prognosis for pediatric HIV.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Vertical transmission of human immunodeficiency virus type 1 (HIV-1) poses a significant risk to infants.
- Predicting survival outcomes in vertically HIV-1 infected children is crucial for clinical management.
- The role of early viral markers in determining prognosis requires further investigation.
Purpose of the Study:
- To assess if plasma p24 antigen levels in the first six months of life predict survival in vertically HIV-1 infected children.
- To establish p24 antigenemia as a potential prognostic marker in pediatric HIV-1 infection.
Main Methods:
- Retrospective analysis of vertically HIV-1 infected infants followed prospectively.
- Quantification of plasma p24 antigen concentration within the first six months of life.
- Stratification of infants by survival duration (died before 2 years vs. survived to 2 years) and comparison of p24 antigen levels using Kaplan-Meier analysis.
Main Results:
- Infants who died before age 2 had a significantly higher median p24 antigen concentration (228 pg/ml) compared to those surviving to age 2 (14 pg/ml).
- A higher proportion of short-term survivors exhibited elevated p24 antigen levels (>100 pg/ml) compared to intermediate-term survivors.
- Survival to 2 years was 91% for infants with p24 antigen levels ≤100 pg/ml versus 39% for those with levels >100 pg/ml in the first six months.
Conclusions:
- Elevated p24 antigenemia in early infancy is strongly associated with reduced survival in vertically HIV-1 infected children.
- Plasma p24 antigen levels during the first six months of life serve as a valuable predictor of clinical outcome in pediatric HIV-1 infection.
Objective:
To determine whether the amount of p24 antigenemia in the first 6 months of life is a predictor of survival in children infected vertically with human immunodeficiency virus type 1.
Methods:
A retrospective study of vertically infected infants and children who were followed prospectively from early infancy and who had quantitation of plasma p24 antigen concentration in the first 6 months of life. Infants were first stratified by duration of survival as infants who died before 2 years of age (short-term survivors) and infants who survived to 2 years of age (intermediate-term survivors). The median p24 antigen concentration and the proportion of infants in each group with high concentrations of antigen were compared. Analyses with and excluding all p24 determinations made after the use of antiretroviral agents were compared Kaplan-Meier product limit analysis was used to compare survival in infants with low and high antigenemia during the first 6 months of life.
Results:
The median p24 antigen concentration in 15 short-term survivors was 228 pg/ml, compared with 14 pg/ml in 26 intermediate-term survivors (p < 0.05). The proportion of children with > 100 pg/ml of p24 was higher in short-term than in intermediate-term survivors (p = 0.01). Survival to 2 years of age in infants in whom all p24 antigen values during the first 6 months of life were 100 pg/ml or less was 91%, in comparison with 39% in infants with values greater than 100 pg/ml (p = 0.0017).
Conclusions:
Elevated p24 antigenemia in the first 6 months of life is associated with shorter survival and may be a useful predictor of outcome.