Early detection of reverse transcriptase activity in plasma of neonates infected with HIV-1: A comparative analysis with RNA-based and DNA-based testing using polymerase chain reaction

Plasma viral load from 71 HIV-1-infected neonates was measured by using Amp -RT, an ultrasensitive quantitative reverse transcriptase (RT) assay and by nucleic acid sequence-based amplification (NASBA), an RNA-based quantitati ve assay. Results were then compared with those obtained from detection of proviral DNA in peripheral blood mononuclear cells (PBMCs) by polymerase ch ain reaction (PCR) using Turnbull analysis. At 5 days of life, 50% of neona tes were positive by Amp-RT, 30% were NASBA positive, and 20% were DNA-PCR positive. Through the first 12 days of life, Amp-RT was more sensitive than either NASBA or DNA-PCR in detecting HIV-1 infection. Amp-RT values correl ated well with NASBA RNA values, with an overall Pearson's r = 0.63 (95% co nfidence interval [CI], 0.40-0.78). In proportional hazards analysis of inf ants aged 14 to 61 days (N = 31), a one-log increase in RNA-based viral loa d was associated with a > fivefold risk of disease progression when using t he U.S. Centers for Disease Control and Prevention (CDC) clinical Category C (CDC-C) or death as an endpoint (p = .014). Kaplan-Meier analysis of thes e data found that RNA viral loads were able to predict disease progression using CDC-C/death as an endpoint (p = .013). Early quantitative viral load measurements may assist clinicians in diagnosing HIV-1 infection, stratifyi ng risk of disease progression, and implementing a treatment plan using hig hly active antiretroviral therapy for infants within the first few weeks of life.