title: Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed.
abstract: BACKGROUND
  Negative results on standard HIV antibody tests have been described among HIV-infected children suppressed on antiretroviral therapy (ART) started early in life. Here, we describe the frequency and predictors of this phenomenon in a well characterized cohort of treated children.
  
  
  METHODS
  We selected samples from 103 HIV-infected children who started ART 14 months of age or less and from 122 children who started 6 months of age or less followed as part of two sequential clinical trials in Johannesburg, South Africa. Children had attained viral suppression on ART and had received ART for between 3 and 6.4 years (mean 4.3 years) when tested for HIV antibody using a standard ELISA (Genescreen HIV1/2 version 2; Bio-rad).
  
  
  RESULTS
  Only children 6 months of age or less when ART was started had negative antibody results when tested after suppression on ART several years later. Negative or low-positive antibody results were observed in 40.0, 37.0 and 27.8% of children starting ART less than 2 months of age, or starting during month 2 or 3, respectively. This dropped to 5.9, 3.5 and 5.3% if ART was started during month 4, 5 and 6, respectively. Higher CD4 percentage prior to ART initiation and no recorded intermittent viremia also predicted negative antibody results.
  
  
  CONCLUSIONS
  Testing negative on standard HIV antibody tests occurs fairly commonly among HIV-infected children who started ART 3 months of age or less and are virally suppressed. It would be prudent in clinical practice to avoid HIV antibody tests among virally suppressed, early-treated children to prevent unnecessary confusion.
authors: aGertrude H. Sergievsky Center, College of Physicians and Surgeons bDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA cCentre for HIV and STIs, National Institute for Communicable Diseases dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa eICAP, Mailman School of Public Health, Columbia University, New York, New York, USA.
authors: Louise
authors: L
authors: Kuhn
authors: Diana B
authors: DB
authors: Schramm
authors: Stephanie
authors: S
authors: Shiau
authors: Renate
authors: R
authors: Strehlau
authors: Francoise
authors: F
authors: Pinillos
authors: Karl
authors: K
authors: Technau
authors: Ashraf
authors: A
authors: Coovadia
authors: Elaine J
authors: EJ
authors: Abrams
authors: Adrian
authors: A
authors: Puren
authors: Caroline T
authors: CT
authors: Tiemessen
mesh_terms: D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents; D015483:HIV Antibodies