title: Antiretroviral Treatment Initiated in the First Month of Life.
abstract: Earlier diagnosis of HIV-infected infants facilitates earlier access to therapy and improved clinical outcomes. The aim of this study was to describe the management of infants who started antiretroviral therapy (ART) in the first month of life.
  
  
  
  A retrospective review was performed on HIV-infected neonates who started ART within the first month of life between January 2013 and March 2015.
  
  
  
  A total of 997 neonates had 1 HIV polymerase chain reaction test. Of the 997 neonates, 26 (2.6%) tested positive for HIV and 22 initiated therapy in the first month of life. The median age of first HIV polymerase chain reaction test was 7 days. Neonates were started on ART within a median of 7 days of their first HIV test, which equated to a median age of 13.5 [interquartile range (IQR) 7-20] days of life. Median gestational age was 35 weeks (IQR 33-38 weeks), and birth weight was 2170 g (IQR 1773-2480). Nineteen (86.4%) had low birth weight (<2.5 kg) and 16 (72.7%) were premature. Median baseline HIV viral loads were log 4.444 copies/mL (IQR 3.457-5.125), median CD4 counts were 1338 (IQR 803-1928) and CD4% percentages were 36.1% (22.2-45.4). All children initiated zidovudine and lamivudine, 10 with lopinavir/ritonavir and 12 with nevirapine. All children in care are now receiving lopinavir/ritonavir. Of the 22 neonates initiated on treatment, 11 are in care (mean age, 2.1 years), and 2 of these infants had a viral load of <50 copies/ mL when last measured.
  
  
  
  Early ART initiation in neonates is feasible. Challenges include safe, palatable regimens and continued close follow-up of mothers and infants.
authors.affiliation: From the *Division of Paediatric Infectious Diseases and Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; †School of Medicine, Imperial College London, London, United Kingdom; ‡Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa; and §Division of Neonatology and Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Lisa
authors.initials: L
authors.lastname: Frigati
authors.forename: Elke
authors.initials: E
authors.lastname: Wynberg
authors.forename: Jean
authors.initials: J
authors.lastname: Maritz
authors.forename: Sandi
authors.initials: S
authors.lastname: Holgate
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D012189:Retrospective Studies; D014773:Virology / Q000379:methods
chemical_list: D019380:Anti-HIV Agents