. 2023 Feb 8;76(3):e744-e747.

doi: 10.1093/cid/ciac695.

Infants Receiving Very Early Antiretroviral Therapy Have High CD4 Counts in the First Year of Life

Bryan S Nelson¹, Camlin Tierney¹, Deborah Persaud², Jennifer Jao^{3

4}, Mark F Cotton⁵, Yvonne Bryson⁶, Anne Coletti⁷, Theodore D Ruel⁸, Stephen A Spector^{9

10}, Christina Reding¹¹, Kira Bacon¹¹, Diane Costello¹², Charlotte Perlowski⁷, Maria Leticia Santos Cruz¹³, Josphat Kosgei¹⁴, Sai Majji¹⁵, Dwight E Yin¹⁶, Patrick Jean-Philippe¹⁶, Ellen G Chadwick^{3

4}; IMPAACT P1115 Team

Affiliations

¹ Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
² Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁴ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
⁵ Department of Pediatrics and Child Health, Family Center for Research with Ubuntu, Stellenbosch University, Tygerberg, South Africa.
⁶ Department of Pediatrics, University of California-Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
⁷ Science Facilitation Department, FHI 360, Durham, North Carolina, USA.
⁸ Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA.
⁹ Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA.
¹⁰ Rady Children's Hospital, San Diego, California, USA.
¹¹ Frontier Science and Technology Research Foundation, Amherst, New York, USA.
¹² IMPAACT Laboratory Center, University of California Los Angeles, Los Angeles, California, USA.
¹³ Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
¹⁴ Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya.
¹⁵ Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
¹⁶ Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.

PMID: 36031390
PMCID: PMC10169385
DOI: 10.1093/cid/ciac695

Infants Receiving Very Early Antiretroviral Therapy Have High CD4 Counts in the First Year of Life

Bryan S Nelson et al. Clin Infect Dis. 2023.

. 2023 Feb 8;76(3):e744-e747.

doi: 10.1093/cid/ciac695.

Authors

Affiliations

¹ Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
² Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁴ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
⁵ Department of Pediatrics and Child Health, Family Center for Research with Ubuntu, Stellenbosch University, Tygerberg, South Africa.
⁶ Department of Pediatrics, University of California-Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
⁷ Science Facilitation Department, FHI 360, Durham, North Carolina, USA.
⁸ Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA.
⁹ Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA.
¹⁰ Rady Children's Hospital, San Diego, California, USA.
¹¹ Frontier Science and Technology Research Foundation, Amherst, New York, USA.
¹² IMPAACT Laboratory Center, University of California Los Angeles, Los Angeles, California, USA.
¹³ Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
¹⁴ Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya.
¹⁵ Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
¹⁶ Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.

PMID: 36031390
PMCID: PMC10169385
DOI: 10.1093/cid/ciac695

Abstract

We followed 54 infants with in utero HIV after initiating very early antiretroviral treatment. At weeks 24 and 48, ≥80% had CD4 ≥1500 cells/mm3 and CD4% ≥25%. Routine Pneumocystis jirovecii pneumonia prophylaxis in the first year of life may not be necessary for all very early treated infants.

Clinical trials registration: NCT02140255.

Keywords: Pneumocystis jirovecii pneumonia; CD4; HIV; cotrimoxazole; neonatal.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. D. P. received a one-time consultation fee from Merck to serve on their scientific advisory board, received an honorarium from the American Society of Pathology, provided expert testimony on behalf of the Children's Hospital of Philadelphia, and serves (unpaid) on the IAS Industry Collaborative Group. D. E. Y. was previously an unpaid technical advisor to the nonprofits Cover the Globe and Maipelo Trust and reports support from Astellas, Chimerix, and Viracor-Eurofins provided to his previous institution, prior to his current work at the National Institutes of Health. E. G. C.'s partner retired from and holds stock in AbbVie; she also received consulting fees from the National Clinicians Consultation Center and was paid for expert testimony by Brown & James P.C. A. C., B. S. N., C. P., C. T., D. P., E. G. C., J. J., M. F. C., S. A. S., and Y. B. report grants from the National Institutes of Health (NIH). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

**Figure 1.**
Infant profile plots of CD4 cell counts and CD4 percentages by concurrent VL status. The dashed vertical line corresponds to the week 24 visit, after which only infants with HIV plasma viral load <200 copies/mL continue to be followed. Horizontal lines are shown at 1500 cells/mm³ and 25%. *Clopper-Pearson exact CI. Abbreviations: CI, confidence interval; HIV, human immunodeficiency virus; VL, viral load.

See this image and copyright information in PMC

References

1. National Pediatric and Family HIV Resource Center and National Center for Infectious Diseases, Centers for Disease Control and Prevention. 1995 Revised guidelines for prophylaxis against Pneumocystis carinii pneumonia for children infected with or perinatally exposed to human immunodeficiency virus. MMWR Recomm Rep 1995; 44(RR-4):1–11. - PubMed
1. Boettiger DC, Law MG, Sohn AH, et al. . Temporal trends in co-trimoxazole use among children on antiretroviral therapy and the impact of co-trimoxazole on mortality rates in children without severe immunodeficiency. J Pediatric Infect Dis Soc 2019; 8:450–60. - PMC - PubMed
1. Panel on Opportunistic Infections in HIV-exposed and HIV-infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Diseases Society of America, and Pediatric Infectious Diseases Society. Available at: https://clinicalinfo.hiv.gov/en/guidelines/pediatric-opportunistic-infec.... Accessed 24 January 2022.
1. World Health Organization . Guidelines on post-exposure prophylaxis for HIV and the use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children: recommendations for a public health approach: December 2014 supplement to the 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Available at: https://apps.who.int/iris/handle/10665/145719. Accessed 24 January 2022. - PubMed
1. Nesheim SR, Kapogiannis BG, Soe MM, et al. . Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the Perinatal AIDS Collaborative Transmission Study, 1986–2004. Pediatrics 2007; 120:100–9. - PubMed

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Infants Receiving Very Early Antiretroviral Therapy Have High CD4 Counts in the First Year of Life

Affiliations

Infants Receiving Very Early Antiretroviral Therapy Have High CD4 Counts in the First Year of Life

Authors

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Abstract

Conflict of interest statement

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