Reduced Time to Suppression Among Neonates With HIV Initiating Antiretroviral Therapy Within 7 Days After Birth

Sara Domínguez-Rodríguez, Alfredo Tagarro, Paolo Palma, Caroline Foster, Thanyawee Puthanakit, Thidarat Jupimai, Nicola Cotugno, Jintanat Ananworanich, Paola Zangari, Eleni Nastouli, María Ángeles Muñoz-Fernández, María Luisa Navarro, Carlo Giaquinto, Paolo Rossi, Louise Kuhn, Pablo Rojo

Research output: Contribution to journalArticlepeer-review

Abstract

There are limited data on infants with HIV starting antiretroviral therapy (ART) in the neonatal period. We investigated the association between the timing of ART initiation and time-to-suppression among infants who tested HIV-positive and initiated ART within the first 28 days of life. The effect was estimated using cumulative probability flexible parametric spline models and a multivariable generalized additive mixed model was performed to test nonlinear associations. Forty-four neonates were included. Nineteen (43.2%) initiated ART within 7 days of life and 25 (56.8%) from 8 to 28 days. Infants treated within 7 days were 4-fold more likely to suppress earlier than those treated after 7 days [Hazard ratio (HR) 4.01 (1.7-9.5)]. For each week the ART initiation was delayed, the probability of suppression decreased by 35% (HR 0.65 [0.46-0.92]). Age at ART start was linearly associated with time-to-suppression. However, a linear association with normally distributed residuals was not found between baseline viral load and time-to-suppression, with no association found when baseline viral loads were ≤5 log(10) copies/mL, but with exponential increase in time-to-suppression with > log5 copies/mL at baseline. Starting ART within 7 days of life led to 4-fold faster time to viral suppression, in comparison to initiation from 8 to 28 days.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalJournal of acquired immune deficiency syndromes (1999)
Volume82
Issue number5
DOIs
Publication statusPublished - Dec 15 2019

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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