ABSTRACT
We evaluated the evolution over time of once-daily antiretroviral therapy in HIV-infected children and its relationship with adherence. An increase on the prevalence of once-daily antiretroviral therapy was observed over time (from 0.9% in 2002 to 44.2% in 2011). There was no difference in adherence regarding once-daily or BID regimens in 2011. Adherence was related to age and pill burden.
Subject(s)
Anti-Retroviral Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , HIV Infections/drug therapy , Medication Adherence , Adolescent , Child , Cohort Studies , Female , Humans , Male , Retrospective StudiesABSTRACT
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.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , HIV Infections/transmission , HIV-1 , Infectious Disease Transmission, Vertical , Antiretroviral Therapy, Highly Active/adverse effects , CD4 Lymphocyte Count , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , HIV Infections/immunology , Humans , Male , Retrospective Studies , Spain/epidemiology , Viral LoadABSTRACT
BACKGROUND: The effects of HAART may differ between children and adults because children have a developing immune system, and the long-term immunological outcome in HIV-infected children on HAART is not well-known. A major aim of our study was to determine CD4+ evolution associated with long-term VL control during 4 years of observation on HAART. METHODS: We carried out a retrospective study on a cohort of 160 vertically HIV-infected children. It was carried out from 1996 to 2004 in six large Spanish pediatric referral hospitals. We compared 33 children who had long-term VL suppression (VL < or = 400 copies/ml) in the first 12 months of follow-up and maintained that level throughout follow-up (Responders-group), and 127 children with persistently detectable VL in spite of ART switches (Non-Responders-group). RESULTS: We observed a quick initial and significant increase in CD4+ counts from the baseline to 12 months on HAART in both groups (p < 0.01). The Non-Responders group sustained CD4+ increases and most of these children maintained high CD4+ level counts (> or = 25%). The Non-Responders group reached a plateau between 26% and 27% CD4+ at the first 12 months of follow-up that remained stable during the following 3 years. However, the Responders group reached a plateau between 30% and 32% CD4+ at 24, 36 and 48 months of follow-up. We found that the Responders group had higher CD4+ count values and higher percentages of children with CD4+ > or = 25% than the Non-Responders group (p < 0.05) after month 12. CONCLUSION: Long-term VL suppression in turn induces large beneficial effects in immunological responses. However, it is not indispensable to recover CD4+ levels.
Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Adolescent , CD4 Lymphocyte Count , Child , Child, Preschool , Drug Administration Schedule , Female , HIV Infections/immunology , Humans , Infant , Male , Retrospective Studies , Viral LoadABSTRACT
El objetivo de este trabajo es estudiar las subpoblaciones de células T vírgenes, memoria y activadas en sangre periférica de 65 niños infectados verticalmente por el HIV, considerando su categoría clínica, inmunológica y los valores de carga viral (CV). Todos los niños HIV fueron tratados con terapia antirretroviral (AR) (26 niños con terapia AR combinada y 39 en terapia AR altamente agresiva). Las subpoblaciones de linfocitos T se analizaron por citometría de flujo con marcaje triple y se expresaron en porcentaje. Las células T CD4+ vírgenes (CD45RA+CD62L+) estuvieron disminuidas en niños con bajo porcentaje CD4+, pero no en niños en estadios avanzados de la enfermedad o con CV elevadas. Por el contrario, las células T CD8+ vírgenes estuvieron disminuidas en niños con bajo porcentaje CD4+, en estadio avanzado de la enfermedad y con CV elevadas. Las células T CD4+ y CD8+ de memoria (CD45RO+) y activadas (CD38+, HLA-DR+ y CD38+HLA-DR+) estuvieron elevadas en niños con bajo porcentaje CD4+, en estadio avanzado de la enfermedad y con CV elevadas. Sin embargo, las células CD4+CD38+ estuvieron más elevadas en los niños HIV con CD4+>25 por ciento que en el grupo control (p<0,001) y más disminuidas en los niños con bajo porcentaje CD4+. El porcentaje de células T CD4+ y CD8+ vírgenes y memoria depende del porcentaje CD4+ más que de la categoría clínica o el valor de CV. Nuestros datos indican una asociación entre bajo porcentaje CD4+ y CV elevadas con la expresión elevada de marcadores de activación celular, pero no así en estadios clínicos avanzados, posiblemente debido al tratamiento antirretroviral.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , HIV Infections , HIV-1 , Infectious Disease Transmission, Vertical , T-Lymphocyte Subsets , Biomarkers , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes , CD8-Positive T-Lymphocytes , Cross-Sectional Studies , HIV Infections , Immunologic Memory , Lymphocyte Count , Viral LoadABSTRACT
El objetivo de este trabajo es estudiar las subpoblaciones de células T vírgenes, memoria y activadas en sangre periférica de 65 niños infectados verticalmente por el HIV, considerando su categoría clínica, inmunológica y los valores de carga viral (CV). Todos los niños HIV fueron tratados con terapia antirretroviral (AR) (26 niños con terapia AR combinada y 39 en terapia AR altamente agresiva). Las subpoblaciones de linfocitos T se analizaron por citometría de flujo con marcaje triple y se expresaron en porcentaje. Las células T CD4+ vírgenes (CD45RA+CD62L+) estuvieron disminuidas en niños con bajo porcentaje CD4+, pero no en niños en estadios avanzados de la enfermedad o con CV elevadas. Por el contrario, las células T CD8+ vírgenes estuvieron disminuidas en niños con bajo porcentaje CD4+, en estadio avanzado de la enfermedad y con CV elevadas. Las células T CD4+ y CD8+ de memoria (CD45RO+) y activadas (CD38+, HLA-DR+ y CD38+HLA-DR+) estuvieron elevadas en niños con bajo porcentaje CD4+, en estadio avanzado de la enfermedad y con CV elevadas. Sin embargo, las células CD4+CD38+ estuvieron más elevadas en los niños HIV con CD4+>25 por ciento que en el grupo control (p<0,001) y más disminuidas en los niños con bajo porcentaje CD4+. El porcentaje de células T CD4+ y CD8+ vírgenes y memoria depende del porcentaje CD4+ más que de la categoría clínica o el valor de CV. Nuestros datos indican una asociación entre bajo porcentaje CD4+ y CV elevadas con la expresión elevada de marcadores de activación celular, pero no así en estadios clínicos avanzados, posiblemente debido al tratamiento antirretroviral. (AU)
