Western Blot Seroreversion Pattern among Uninfected Children Perinatally Exposed to Human Immunodeficiency Virus
Over the years, the seroreversion time among uninfected children perinatally exposed to Human Immunodeficiency Virus (HIV) has increased. The mechanisms for this phenomenon are not well understood. In addition, little is known regarding seroreversion pattern of antibodies to HIV among exposed but uninfected children born to HIV-1 infected women in the era of highly active antiretroviral therapy. The objective of our study was to determine the HIV antibody seroreversion patterns in this unique population.
A retrospective review of infants born to HIV-1-infected mothers from January 1, 2009 to December 31, 2013 evaluated at the University of South Alabama Family Specialty Clinic was performed. Infants were included in the study if HIV infection was ruled out by HIV polymerase chain reaction assays, documentation of seroreversion and if they have had at least one HIV western blot test result during the same period. Demographic, clinical and laboratory information on the infant and mother were collected from the medical records. Uninfected infants who had not seroreverted yet, even if they have had a western blot test at some point, were excluded.
Fifty-two infants were included in the study and all of them seroreverted by a mean age 466 days (r, 278-980, median 422). Out of the 52, 31 (60%) were males and 41 (79%) were African-American. Mean gestational age was 36.5 weeks (r, 27-40, median 38). Mean maternal age and duration of maternal infection at the time of delivery was 28.5 years and 59.3 months, respectively. Latest viral load before delivery was <100 copies/ml for 52% of the mothers, while 25% had >1000 copies/ml.
Aggregate of the infants' specific HIV antibody by western blot were plotted over time to determine the pattern of antibody decay from 0 to 84 weeks of life at 12 week intervals (see graph). Antibody decay occurred more rapidly for the p18 antibody while p24 antibody was detected the longest.
Conclusion: p18 antibody decay occurs first and may be an early predictor of full seroreversion among HIV exposed but uninfected infants. Knowing the pattern of antibody loss may have implications in clarifying the status of an infant in a more expedited fashion.
T. Miller, None
B. Estrada, None