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Published on: April 9, 2014
[Responses to antiretroviral treatments in vertically HIV-1-infected children]
Salvador Resino1, José M Bellón, Dolores Gurbindo
1Servicio de Inmunología. Hospital General Universitario Gregorio Marañon. Madrid. Spain.
Insights
Highly active antiretroviral therapy (HAART) significantly improved viral load control and CD4+ T-cell increases in HIV-infected children compared to combination therapy (CT). Baseline CD4+ T-cell counts and viral load effectively predicted treatment response.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Virology
Context:
- Antiretroviral therapy (ART) is crucial for managing vertically transmitted HIV-1 infection in children.
- Evaluating treatment efficacy requires monitoring viral load (VL) and CD4+ T-lymphocyte counts.
- Understanding factors influencing treatment response is key for optimizing pediatric HIV care.
Purpose:
- To assess the probability of achieving viral load (VL) reduction and CD4+ T-lymphocyte increase within 36 months of ART initiation in HIV-infected children.
- To analyze the impact of baseline data on treatment outcomes.
- To compare the effectiveness of combination therapy (CT) versus highly active antiretroviral therapy (HAART).
Summary:
- This retrospective multicenter study analyzed 128 vertically HIV-1 infected children on ART.
- HAART demonstrated faster median times to achieve VL < 400 copies/ml (10.9 months) and CD4+ T-cell increase (11 months) compared to CT (VL: 29.6 months, CD4+: 35.7 months).
- Baseline factors like low CD4+ T-cells and high VL were associated with better CD4+ T-cell increases, while low baseline VL predicted viral load reduction with HAART.
Impact:
- HAART is more effective than CT for viral load suppression and CD4+ T-cell recovery in children with HIV-1.
- Baseline immunologic and virologic markers are valuable predictors of ART response in pediatric HIV.
- These findings can inform treatment strategies and monitoring protocols for children living with HIV.
Background And Objective:
Our goal was to determine the probability of achieving a fall-off of viral load (VL) and an increase of CD4+T-lymphocytes by 36 months from the initiation of antiretroviral therapy (ART) in a cohort of HIV-infected children according to their baseline data.
Patients And Method:
This was retrospective multicenter observational study of virologic and immunologic markers in 128 HIV-1-vertically infected children on ART: 55 HIV-infected children on combination therapy (CT), and 73 HIV-infected children on highly active antiretroviral therapy (HAART). Viral load (VL) was quantified using a standard molecular assay. CD4+ and CD8+ T-cells subsets were determined by flow cytometry.
Results:
The median time for a 10% rise of CD4+ T-lymphocytes was 35.7 months (95% confidence interval [95% CI], 15.5-55.9) after starting CT, and 11 months (95% CI, 7,7-14.3) after starting HAART. The median time for a VL fall to < 400 copies/ml was 29.6 months (95% CI, 9.4-49.7) after starting CT, and the median time for a VL fall to < 400 copies/ml was 10.9 months (95% CI, 0-21.9) after starting HAART. A 10% increase of CD4+ T-cells over baseline was associated with HAART, low CD4+ T-cells and high VL. On the other hand, a VL fall lower than 400 copies/ml was associated with HAART and low baseline VL.
Conclusions:
Our data indicate that HAART was better than CT in the control of VL and CD4+ T-cell increase. Also, baseline CD4+ T-cell and VL values helped to determine the response to ART in HIV-1 infected children.
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