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Multicenter Study
. 2011 Jun 1;57(2):165-73.
doi: 10.1097/QAI.0b013e318215c7b1.

Antiretroviral treatment of US children with perinatally acquired HIV infection: temporal changes in therapy between 1991 and 2009 and predictors of immunologic and virologic outcomes

Russell B Van Dyke  1 , Kunjal Patel, George K Siberry, Sandra K Burchett, Stephen A Spector, Miriam C Chernoff, Jennifer S Read, Lynne M Mofenson, George R Seage 3rd; Pediatric HIV/AIDS Cohort Study
Collaborators, Affiliations
Multicenter Study

Antiretroviral treatment of US children with perinatally acquired HIV infection: temporal changes in therapy between 1991 and 2009 and predictors of immunologic and virologic outcomes

Russell B Van Dyke et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Advances in therapy have allowed children with perinatal HIV infection in the United States to survive into adolescence. We sought to describe the disease status of a large cohort of such children and identify predictors of their current CD4 count and HIV viral load (VL).

Methods: The Pediatric HIV/AIDS Cohort Study AMP Protocol is an ongoing prospective study conducted at 15 sites in the United States. Between 2007 and 2009, we enrolled a population-based sample of 451 children with perinatal HIV who were 7-16 years of age at entry.

Results: The median age of subjects at entry was 12.2 years, 53% were female, 70% were African-American, and 24% Hispanic. Their median entry CD4% was 33%, and 78% had a CD4% ≥25%; 68% had a suppressed VL. The more recent birth cohorts (1994-2002) had a significantly higher CD4% over time than the earliest birth cohort (1991-1993). The significant independent predictors of a higher CD4% at entry were a suppressed entry VL, a higher nadir CD4%, and starting antiretroviral therapy at a younger age. The mean CD4% at entry for children with a nadir CD4% ≥25% was 9.5% higher than for those with a nadir CD4% <15% (P < 0.001). Independent predictors of a suppressed entry VL were membership in a recent birth cohort, male gender, highly active combination antiretroviral therapy use at entry, and fewer prior antiretroviral therapy regimens.

Conclusions: Most children with perinatal HIV maintain virologic suppression and good CD4 values. Earlier treatment results in better immune outcome.

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Figures

Figure 1
Figure 1
Trends in antiretroviral therapy use from 1993–2008. HAART: highly active combination antiretroviral therapy; NRTI: nucleoside/nucleotide reverse-transcriptase inhibitors; NNRTI: non-nucleoside reverse transcriptase inhibitor; PI: protease inhibitor; FI: fusion inhibitor; II: integrase inhibitor; EI: entry inhibitor.
Figure 2
Figure 2
Mean CD4% by age for each birth cohort and estimated difference in mean CD4% between birth cohorts.
See this image and copyright information in PMC

References

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