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Long-term effects of highly active antiretroviral therapy in pretreated, vertically HIV type 1-infected children: 6 years of follow-up.
Clin Infect Dis 2006; 42(6):862-9CI

Abstract

BACKGROUND

Several studies of children with human immunodeficiency virus (HIV) type 1 infection have demonstrated sustained increases in CD4+ cell count, even when virological failure has occurred after receipt of highly active antiretroviral therapy (HAART), but these studies were of limited duration. Moreover, the CD4+ cell count threshold at which antiretroviral treatment should be initiated is still unsettled. The aim of this study was to define the long-term impact of HAART on CD4+ cell percentage and viral load according to CD4+ cell percentages before HAART was initiated.

METHODS

We conducted a retrospective study of 113 pretreated HIV-1-infected children stratified by pre-HAART CD4+ cell percentage (<5%, 5%-15%, 15%-25%, and >25%). The inclusion criteria were as follows: initiating HAART with a protease inhibitor, having 6 years of follow-up after starting HAART, having a CD4+ cell count or viral load recorded before initiation of HAART, and having received mono- or dual-nucleoside therapy before starting HAART.

RESULTS

During the first 2 years of HAART, HIV-1-infected children experienced a significant increase in CD4+ cell percentage and a decrease in viral load (P<.05). During their last 4 years of receiving HAART, we found a significant decrease in viral load but not an increase in CD4+ cell percentage, because the CD4+ cell percentage reached a plateau after the second year of HAART. Moreover, children with CD4+ cell percentages of <5% at baseline did not achieve CD4+ cell percentages of >25% after 6 years of HAART. Children with CD4+ cell percentages of 5%-25% at baseline had a strong negative association with achieving CD4+ cell percentages of >30% for at least 6 and 12 months but not with achieving CD4+ cell percentages of >30% for at least 24 months.

CONCLUSIONS

Long-term HAART allowed for restoration of CD4+ cell counts and control of viral loads in HIV-1-infected children. However, initiating HAART after severe immunosuppression has occurred is detrimental for the restoration of the CD4+ cell count.

Authors+Show Affiliations

Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain. sresino.hgugm@salud.madrid.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16477566

Citation

Resino, Salvador, et al. "Long-term Effects of Highly Active Antiretroviral Therapy in Pretreated, Vertically HIV Type 1-infected Children: 6 Years of Follow-up." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 42, no. 6, 2006, pp. 862-9.
Resino S, Resino R, Micheloud D, et al. Long-term effects of highly active antiretroviral therapy in pretreated, vertically HIV type 1-infected children: 6 years of follow-up. Clin Infect Dis. 2006;42(6):862-9.
Resino, S., Resino, R., Micheloud, D., Gurbindo Gutiérrez, D., Léon, J. A., Ramos, J. T., ... Muñoz-Fernández, A. (2006). Long-term effects of highly active antiretroviral therapy in pretreated, vertically HIV type 1-infected children: 6 years of follow-up. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 42(6), pp. 862-9.
Resino S, et al. Long-term Effects of Highly Active Antiretroviral Therapy in Pretreated, Vertically HIV Type 1-infected Children: 6 Years of Follow-up. Clin Infect Dis. 2006 Mar 15;42(6):862-9. PubMed PMID: 16477566.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term effects of highly active antiretroviral therapy in pretreated, vertically HIV type 1-infected children: 6 years of follow-up. AU - Resino,Salvador, AU - Resino,Rosa, AU - Micheloud,Dariela, AU - Gurbindo Gutiérrez,Dolores, AU - Léon,Juan Antonio, AU - Ramos,José Tomás, AU - Ciria,Luis, AU - de José,Isabel, AU - Mellado,José, AU - Muñoz-Fernández,Angeles, AU - ,, Y1 - 2006/02/09/ PY - 2005/11/03/received PY - 2005/11/04/accepted PY - 2006/2/16/pubmed PY - 2006/7/25/medline PY - 2006/2/16/entrez SP - 862 EP - 9 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 42 IS - 6 N2 - BACKGROUND: Several studies of children with human immunodeficiency virus (HIV) type 1 infection have demonstrated sustained increases in CD4+ cell count, even when virological failure has occurred after receipt of highly active antiretroviral therapy (HAART), but these studies were of limited duration. Moreover, the CD4+ cell count threshold at which antiretroviral treatment should be initiated is still unsettled. The aim of this study was to define the long-term impact of HAART on CD4+ cell percentage and viral load according to CD4+ cell percentages before HAART was initiated. METHODS: We conducted a retrospective study of 113 pretreated HIV-1-infected children stratified by pre-HAART CD4+ cell percentage (<5%, 5%-15%, 15%-25%, and >25%). The inclusion criteria were as follows: initiating HAART with a protease inhibitor, having 6 years of follow-up after starting HAART, having a CD4+ cell count or viral load recorded before initiation of HAART, and having received mono- or dual-nucleoside therapy before starting HAART. RESULTS: During the first 2 years of HAART, HIV-1-infected children experienced a significant increase in CD4+ cell percentage and a decrease in viral load (P<.05). During their last 4 years of receiving HAART, we found a significant decrease in viral load but not an increase in CD4+ cell percentage, because the CD4+ cell percentage reached a plateau after the second year of HAART. Moreover, children with CD4+ cell percentages of <5% at baseline did not achieve CD4+ cell percentages of >25% after 6 years of HAART. Children with CD4+ cell percentages of 5%-25% at baseline had a strong negative association with achieving CD4+ cell percentages of >30% for at least 6 and 12 months but not with achieving CD4+ cell percentages of >30% for at least 24 months. CONCLUSIONS: Long-term HAART allowed for restoration of CD4+ cell counts and control of viral loads in HIV-1-infected children. However, initiating HAART after severe immunosuppression has occurred is detrimental for the restoration of the CD4+ cell count. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/16477566/Long_term_effects_of_highly_active_antiretroviral_therapy_in_pretreated_vertically_HIV_type_1_infected_children:_6_years_of_follow_up_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/500412 DB - PRIME DP - Unbound Medicine ER -