Sero-negative Antibody Status in HIV-Infected Children Initiated on Early Anti-Retroviral Therapy in Jos, Nigeria

Abstract

Aim: To determine the association between the age at initiation of anti-retroviral therapy (ART) and the 18 month antibody status of human immunodeficiency virus (HIV)-infected children in Jos, Nigeria. Study Design: This was a retrospective cohort study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic at Jos University Teaching Hospital, Jos, Nigeria between July 2008 and June 2012. Methods: We reviewed the clinical records of all children confirmed to be HIV-infected with 2 positive HIV deoxyribonucleic acid polymerase chain reaction (DNA PCR) results who were initiated on ART before 12months of age. We studied the association between the age at initiation of ART and their antibody status at 18 months of age. We also studied the association between the viral load and the antibody status. Result: Seventy-three HIV-infected children were initiated on ART at <12 months of age, 66 of these had antibody tests at 18-21 months of age. Nineteen (29%) of the 66 children were negative for rapid antibody test. Those that were initiated on ART at <6 months of age had 5 times the odds ratio of being rapid antibody test negative compared to those who were initiated at ≥6 months of age (AOR=5.23 (1.82-19.66), P=0.002). All the children with negative rapid antibody tests were virally suppressed while all those with detectable viral load were positive for rapid antibody tests. Conclusion: Antibody tests alone cannot be used to determine whether ART should be stopped in children where a definitive diagnosis does not exist. Improved access to affordable, technically simple DNA PCR testing is essential for the appropriate management of HIV-exposed infants in resource limited settings.