Newborns with HIV can be identified and treated within hours

  • Technau KG & al.
  • Lancet HIV
  • 8 Nov 2018

  • curated by Emily Willingham, PhD
  • Medical News
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Takeaway

  • Infants born with HIV can be identified and started on antiretroviral therapy (ART) within hours of birth.

Why this matters

  • Beginning ART after HIV diagnosis at birth is a growing focus of pediatric care.
  • ART coverage for infants remains low in many areas, including in South Africa.

Key results

  • 98% of infants with test-confirmed HIV infection were started on ART.
  • Median age at ART start, from era 1 to era 3, dropped from 9 (interquartile range, 6-25) days to 2 (1-8) days.
  • Addition of point-of-care (POC) testing allowed more frequent ART start within 48 hours of birth.
  • Mortality probability by age 12 months was 19% (95% CI, 8%-39%) with additional POC testing vs 9% (3%-27%; P=.31) without it.
  • 78% of infants started on ART at the study site were still in care at age 12 months.

Study design

  • 5449 infants, South Africa, tested in 3 eras:
    • Era 1, from September 2013: high-risk, HIV-exposed infants (n=201).
    • Era 2, from June 2014: all HIV exposed infants offered lab-based PCR tests (n=798).
    • Era 3, from October 2014: if available, POC tests added to lab-based testing (n=4450).
  • Funding: NIH; others. 

Limitations

  • Few with confirmed infection.
  • Single-site with rapid lab-turnaround time.

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