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

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 non-linear 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 (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 VL 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 > 5 log(10) copies/ml at baseline. Starting ART within 7 days of life led to 4-fold faster time to viral suppression, in comparison to initiation in 8 to 28 days.