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Early antiretroviral therapy and mortality among HIV-infected infants

Avy Violari1, Mark F Cotton, Diana M Gibb

  • 1Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa. violari@mweb.co.za

The New England Journal of Medicine
|November 21, 2008
PubMed

Insights

Early antiretroviral therapy significantly reduced infant mortality and HIV progression in infants. This crucial intervention led to a 76% decrease in early deaths and a 75% reduction in disease progression.

Area of Science:

  • Pediatric infectious diseases
  • HIV/AIDS research
  • Clinical trial methodology

Background:

  • Infant mortality is a significant concern in high HIV-1 seroprevalence regions.
  • The Children with HIV Early Antiretroviral Therapy (CHER) trial investigated treatment strategies for HIV-infected infants.

Purpose of the Study:

  • To compare the outcomes of deferred versus early initiation of antiretroviral therapy in HIV-infected infants.
  • To evaluate the impact of early treatment on infant mortality and disease progression.

Main Methods:

  • Randomized trial involving HIV-infected infants aged 6-12 weeks with CD4 percentage >= 25%.
  • Two groups: deferred therapy (initiated based on CD4 count or clinical criteria) and early therapy (immediate initiation until age 1 or 2 years).
  • Primary outcomes included mortality and disease progression (CDC stage C or severe stage B).

Main Results:

  • Early therapy group showed significantly lower mortality (4% vs. 16%) and disease progression (6% vs. 26%) compared to the deferred therapy group.
  • Hazard ratios for death and disease progression were 0.24 and 0.25, respectively, favoring early therapy.
  • No permanent drug discontinuations were noted; minor side effects like neutropenia and anemia were managed by substituting zidovudine.

Conclusions:

  • Early diagnosis and initiation of antiretroviral therapy dramatically reduce early infant mortality by 76%.
  • Early antiretroviral therapy significantly decreases HIV progression by 75%.
  • The CHER trial demonstrated the critical benefit of prompt treatment for HIV-infected infants.
Abstract

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