A Clinical Score to Support Antiretroviral Management of HIV-exposed Infants on the Day of Birth

Autor: Steven Nesheim, Shubha Rao, Charles E. Rose, Margaret A. Lampe, Kristen Mahle Gray, Sonia Singh, Yi Pan
Rok vydání: 2019
Předmět:
Microbiology (medical)
Pediatrics
medicine.medical_specialty
Anti-HIV Agents
HIV exposure
Human immunodeficiency virus (HIV)
MEDLINE
Mothers
HIV Infections
medicine.disease_cause
03 medical and health sciences
0302 clinical medicine
Pregnancy
immune system diseases
030225 pediatrics
Humans
Medicine
Public Health Surveillance
030212 general & internal medicine
Pregnancy Complications
Infectious
Disease management (health)
health care economics and organizations
business.industry
Infectious disease transmission
Infant
Newborn
Parturition
Disease Management
virus diseases
Bayes Theorem
medicine.disease
Infectious Disease Transmission
Vertical
United States
Drug Combinations
Logistic Models
Infectious Diseases
Pediatrics
Perinatology and Child Health
HIV-1
behavior and behavior mechanisms
Female
business
Zdroj: Pediatric Infectious Disease Journal. 38:939-943
ISSN: 0891-3668
DOI: 10.1097/inf.0000000000002374
Popis: The benefits of combination antiretroviral (ARV) prophylaxis for infants whose HIV exposure is recognized near birth have been established, and the benefits of early ARV therapy are well known. Decisions about ARVs can be supported by the probability that the child has acquired HIV.Using 2005-2010 data from Enhanced Perinatal Surveillance of the Centers for Disease Control and Prevention, we developed a tool for use at birth to help predict HIV acquisition of HIV-exposed infants to support ARV management. A logistic regression model, fit using a fully Bayesian approach, was used to determine maternal variables predictive of infant HIV acquisition. We created a score index from these variables, established the sensitivity and specificity of each possible score, and determined the distribution of scores among infants, with and without HIV, in our study population.Multivariable analysis of data from 8740 HIV-exposed infants (176 infected and 8564 uninfected) yielded 4 maternal variables in the perinatal HIV acquisition prediction model: sexually transmitted infection, substance use, last HIV viral load before delivery and ARV use. Using the regression coefficient estimates, we rescaled each possible score to make the maximum score equal to 100. For each score, sensitivity and specificity were determined; the area under the receiver operating characteristic curve was 0.79. Median index scores for infants with HIV and without HIV were 43 (first quartile 27 and third quartile 60), and 12 (first quartile, 0 and thirs quartile, 29), respectively.Decisions to begin infants on 3 ARVs-whether considered therapeutic or prophylactic-can be supported by data available on the day of birth.
Databáze: OpenAIRE
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