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. 2009 Aug 26:9:140.
doi: 10.1186/1471-2334-9-140.

Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy

Elena Chiappini  1 , Luisa Galli, Pier-Angelo Tovo, Clara Gabiano, Catiuscia Lisi, Stefania Bernardi, Alessandra Viganò, Alfredo Guarino, Carlo Giaquinto, Susanna Esposito, Raffaele Badolato, Cesare Di Bari, Raffaella Rosso, Orazio Genovese, Massimo Masi, Antonio Mazza, Maurizio de Martino
Affiliations

Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy

Elena Chiappini et al. BMC Infect Dis. .

Abstract

Background: Early highly active antiretroviral therapy (HAART), started within the first months of age, has been proven to be the optimal strategy to prevent immunological and clinical deterioration in perinatally HIV-infected children. Nevertheless, data about long-term follow-up of early treated children are lacking.

Methods: We report data from 40 perinatally HIV-infected-children receiving early HAART, with a median follow-up period of 5.96 years (interquartile range [IQR]:4.21-7.62). Children were enrolled at birth in the Italian Register for HIV Infection in Children. Comparison with 91 infected children born in the same period, followed-up from birth, and receiving deferred treatment was also provided.

Results: Nineteen children (47.5%) were still receiving their first HAART regimen at last follow-up. In the remaining children the first regimen was discontinued, after a median period of 3.77 years (IQR: 1.71-5.71) because of viral failure (8 cases), liver toxicity (1 case), structured therapy interruption (3 cases), or simplification/switch to a PI-sparing regimen (9 cases). Thirty-nine (97.5%) children showed CD4+ T-lymphocyte values>25%, and undetectable viral load was reached in 31 (77.5%) children at last visit. Early treated children displayed significantly lower viral load than not-early treated children, until 6 years of age, and higher median CD4+ T-lymphocyte percentages until 4 years of age. Twenty-seven (29.7%) not-early treated vs. 0/40 early treated children were in clinical category C at last follow-up (P < 0.0001).

Conclusion: Our findings suggest that clinical, virologic and immunological advantages from early-HAART are long-lasting. Recommendations indicating the long-term management of early treated children are needed.

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Figures

Figure 1
Figure 1
CDC Category C event-free survival in children receiving early (- - - dotted line) and not-early HAART (--- solid line). early HAART 40(0) 38 (0) 36(0) 35(0) 33(0) 31(0) 20(0) 14(0) 8(0) 1(0) Patient number (clinical event number). not-early HAART 91(20) 62 (3) 55 (0) 51(1) 49 (2) 44 (0) 38 (0) 34(1) 27(0) 22(0) Patient number (clinical event number).
See this image and copyright information in PMC

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