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Response to planned treatment interruptions in HIV infection varies across childhood

    AIDS (London, England)
    |December 17, 2009
    PubMed

    Insights

    Planned treatment interruptions (PTIs) in children with HIV were safe, with no serious clinical outcomes. Younger children showed better immune recovery after stopping antiretroviral therapy (ART).

    Area of Science:

    • Pediatric Infectious Diseases
    • Clinical Immunology
    • Virology

    Background:

    • Chronic HIV infection in children requires ongoing management.
    • Antiretroviral therapy (ART) is standard care, but treatment interruptions are being explored.
    • The Paediatric European Network for Treatment of AIDS 11 trial investigated planned treatment interruptions (PTIs).

    Purpose of the Study:

    • To compare the clinical, immunological, and virological outcomes of CD4-guided planned treatment interruptions (PTIs) versus continuous antiretroviral therapy (ART) in children with chronic HIV.
    • To assess the safety and efficacy of intermittent ART strategies.

    Main Methods:

    • A multicentre, randomized, open-label, phase II trial involving 109 children with HIV.
    • Participants were randomized to either continuous ART or CD4-guided PTIs.
    • ART was restarted in the PTI group if CD4% dropped below 20% or after 48 weeks off therapy. Primary outcome was CDC stage C event, death, or severe CD4 decline.

    Main Results:

    • No deaths or new CDC stage C events occurred in either group.
    • A small proportion of children in both groups met the primary outcome (2% continuous ART vs. 7% PTI; P=0.2).
    • Lower nadir CD4% predicted faster CD4 decline after stopping ART, while younger age and higher nadir CD4% predicted longer periods off ART and better immune recovery.

    Conclusions:

    • CD4-guided planned treatment interruptions (PTIs) appear safe in children with chronic HIV, with no severe clinical consequences observed in this trial.
    • Younger children demonstrated superior CD4 cell count recovery following PTIs.
    • Further research is needed to establish the role of PTIs in pediatric HIV management, especially with evolving treatment guidelines recommending early ART initiation.
    Abstract

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