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Sex Differences in Antiretroviral Therapy Initiation in Pediatric HIV Infection

Masahiko Mori1, Emily Adland1, Paolo Paioni1

  • 1Department of Paediatrics, University of Oxford, Oxford, United Kingdom.

Plos One
|July 8, 2015
PubMed

Insights

Sex differences in HIV-infected children show females have higher CD4 counts. Females initiated antiretroviral therapy (ART) later but had better immune recovery. Differential CD4 thresholds for ART initiation by sex may improve treatment.

Area of Science:

  • Pediatric Infectious Diseases
  • Immunology
  • HIV/AIDS Research

Background:

  • Males typically experience greater infection incidence and severity in childhood.
  • The underlying biological basis for sex differences in childhood infections remains poorly understood.
  • Understanding these differences could lead to novel disease reduction strategies.

Purpose of the Study:

  • To investigate sex differences in HIV-infected children regarding antiretroviral therapy (ART) initiation.
  • To analyze sex-based disparities in post-treatment outcomes among pediatric HIV patients.
  • To explore potential sex-specific considerations for optimizing ART initiation criteria.

Main Methods:

  • Analysis of a South African cohort comprising 2,101 HIV-infected children.
  • Comparison of CD4+ T-cell counts and percentages between sexes in ART-naïve and HIV-uninfected neonates.
  • Evaluation of ART initiation rates, reasons for initiation (CD4 count vs. clinical disease), and immune reconstitution post-ART.

Main Results:

  • ART-naïve HIV-infected females exhibited significantly higher absolute CD4+ counts and CD4% than age-matched males.
  • HIV-uninfected female neonates also showed higher absolute CD4 counts and CD4% compared to males.
  • Females were initiated on ART less frequently based on CD4 criteria but more frequently due to clinical disease above thresholds, experiencing more rapid and complete immune reconstitution post-ART. Wasting and stunting were significant morbidities in females initiated on ART above CD4 thresholds.

Conclusions:

  • Significant sex differences exist in HIV infection dynamics and treatment response in children.
  • Females demonstrate better immune status pre-ART and superior immune recovery post-ART.
  • Optimal treatment strategies for HIV-infected children may necessitate sex-differentiated CD4 count thresholds for ART initiation.

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