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Patterns of plasma human immunodeficiency virus type 1 RNA response to highly active antiretroviral therapy in
S A Spector1, K Hsia, F H Yong
1Dept. of Pediatrics, University of California, San Diego, La Jolla, CA 92093-0672, USA. saspector@ucsd.edu
Insights
Highly active antiretroviral therapy (HAART) rapidly reduces human immunodeficiency virus type 1 (HIV-1) RNA in children. Most children achieved viral loads below 400 copies/mL within 4 weeks, with significant suppression by 20 weeks.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Highly active antiretroviral therapy (HAART) is crucial for managing pediatric HIV-1 infection.
- Understanding the kinetics of viral load decline is essential for treatment monitoring.
Purpose of the Study:
- To determine the time to achieve specific plasma human immunodeficiency virus type 1 (HIV-1) RNA levels (<400 and <50 copies/mL) in children on HAART.
- To identify factors influencing the achievement of durable virological and immunological responses.
Main Methods:
- Prospective study analyzing plasma HIV-1 RNA levels and CD4 lymphocyte counts in children receiving HAART.
- HAART regimens included efavirenz, nelfinavir, and nucleoside reverse-transcriptase inhibitors.
Main Results:
- Median time to achieve plasma HIV-1 RNA <400 copies/mL was 4 weeks.
- Median time to achieve plasma HIV-1 RNA <50 copies/mL was 20 weeks.
- Higher baseline viral load impacted suppression; CD4 count increase >70 cells/microL by 20 weeks predicted durable benefits.
Conclusions:
- HAART demonstrates rapid and effective viral suppression in children with HIV-1.
- Established time frames for viral load reduction can guide the evaluation of new antiretroviral therapies.
- Monitoring viral load and CD4 counts is critical for assessing treatment efficacy and long-term outcomes.
Abstract:
This study examined the rate of decline in plasma human immunodeficiency virus type 1 (HIV-1) RNA levels to <400 and <50 copies/mL in children receiving highly active antiretroviral therapy (HAART) consisting of efavirenz, nelfinavir, and 1 or 2 nucleoside reverse-transcriptase inhibitors. Children receiving HAART achieved a plasma HIV-1 RNA level <400 copies/mL by a median of 4 weeks after initiation of therapy and a decline to <50 copies/mL by 20 weeks. Baseline plasma HIV-1 RNA levels affected the likelihood of achieving potent and sustained virus suppression, and children whose CD4 lymphocyte counts increased >70 cells/microL by 20 weeks on therapy were more likely to achieve durable virological and immunological benefit. These data provide time frames for virus suppression after the initiation of HAART that should be useful in evaluating the potential efficacy and durability of response of newly instituted combination antiretroviral therapy in HIV-1-infected children.