CD4 Cell Response to Antiretroviral Therapy in Children with Vertically Acquired HIV Infection: Is It Associated with Age at Initiation?

Newell, Marie‐Louise; Giaquinto, Carlo; Rampon, Osvalda; Giacomet, Vania; Rossi, Anita De; Grosch-Wörner, I.; Mok, Jacqueline; Bates, I.; José, Isabel de; Hawkins, Federico; Garcia-Rodriguez, Maricruz M.C.; Guevara, Concepción Ladrón de; Peña, JM; Garcia, Juan Julián J. Gonzalez; Lopez, José Ramón Arribas; Asensi-Botet, F.; Otero, Ma Carmen; Pérez-Tamarit, D; Orti, Ana; Miguel, M.J. San; Scherpbier, Henriëtte J.; Kreyenbroek, M.; Boer, Kees; Bohlin, Ann Britt; Belfrage, Erik; Navér, Lars; Levy, Jack S.; Hainaut, Marc; Peltier, Alexandre; Goetghebuer, Tessa; Barlow, Patricia; Ferrazin, Antonio; Bassetti, Dante; Maria, Andrea De; Gotta, Cristina; Mur, Antonio; López-Vílchez, María Ángeles; Payà, Antoni; Carreras, Ramón; Valerius, NH

doi:10.1086/500842

Cited by 61 publications

(26 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite their greater rate of recovery, children failed to catch up to infant CD4% and CD4-for-age following two years of ART. This is consistent with previous studies[17,18,25,46,47]. A recent study from Uganda and Zimbabwe found lower CD4-for-age at ART initiation was associated with both older age at ART initiation and more rapid initial slope in CD4-for-age reconstitution; long-term predicted CD4 count was higher among children who initiated ART at a younger age in that study[19].…”

Section: Discussionsupporting

confidence: 91%

Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children

Ásbjörnsdóttir

Hughes

Wamalwa

et al. 2016

Aids

View full text Add to dashboard Cite

Background Virologic and immunologic responses to antiretroviral treatment (ART) in infants may differ from older children due to immunologic, clinical or epidemiologic characteristics. Methods Longitudinal ART responses were modeled and compared in HIV-infected infants and children enrolled in cohorts in Nairobi, Kenya. Participants were enrolled soon after HIV diagnosis, started on ART, and followed for two years. Viral load decline was compared between infant and child cohorts using a nonlinear mixed effects model and CD4% reconstitution using a linear mixed effects model. Results Among 121 infants, median age at ART was 3.9 months; among 124 children, median age was 4.8 years. At baseline, viral load (VL) was higher among infant than children (6.47 vs. 5.91 log10 copies/ml, p<0.001). Infants were less likely than children to suppress viral load to <250 copies/ml following 6 months of ART (32% infants vs. 73% children p<0.0001). CD4% was higher at baseline in infants than children (19% vs. 7.3%, p<0.001). Older children had more rapid CD4% reconstitution than infants, but failed to catch up to infant CD4%, Conclusion Despite substantially higher CD4% at ART initiation, viral suppression was significantly slower among infants than older children. New strategies are needed to optimize infant outcomes on ART.

show abstract

Section: Discussionsupporting

confidence: 91%

Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children

Ásbjörnsdóttir

Hughes

Wamalwa

et al. 2016

Aids

View full text Add to dashboard Cite

show abstract

“…Results were unconclusive. Four studies [25][26][27][28] concluded the absence of influence of age at baseline and five studies [14,23,[29][30][31] [16]. In our study, mean CD4 + % was normal in both cohorts.…”

Section: Discussionsupporting

confidence: 54%

“…Influence of age at baseline, independently of immunological status, was studied in European [23,[25][26][27][28][29] and a few African cohorts (1-8.7 years follow-up) [14,30]. Results were unconclusive.…”

Section: Discussionmentioning

confidence: 99%

Virological and Immunological Long-Term Outcome of Human Immunodeficiency Virus-1 Infected Children Treated before One Year and after Two Years of Age in a Resource-Limited Setting of South Africa

J¹,

Ruelle²,

Goubau³

et al. 2017

J AIDS Clin Res

View full text Add to dashboard Cite

“…Research associated with a low baseline CD4 cell count in both resource-rich 29,30 and lowincome countries. 9,10,12,13 Earlier access to treatment could prevent many deaths.…”

Section: M-f Anaky Et Al Paediatric Antiretroviral Therapy In Côte Dmentioning

confidence: 99%

Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

Mf¹,

Duvignac

Wemin³

et al. 2009

Bull. World Health Organ.

View full text Add to dashboard Cite

Entry into the programmeThe Aconda programme adopted a comprehensive family-based approach. Health-care workers were trained to offer HIV testing to every pregnant woman attending antenatal clinics and to encourage HIV-infected mothers to bring their children and partners with them for testing and counselling. Each pregnant woman with an HIV infection was immediately referred for an adult consultation. She then received PMTCT therapy, either a short regimen or ART depending on her clinical and immunological status, and underwent assessment at both antenatal and adult clinics. 18Children aged ≤ 15 years entered the Aconda programme in one of two ways: (i) after referral for HIV testing at the age of ≥ 6 weeks because their mother had been diagnosed with HIV infection and had received PMTCT therapy, or (ii) after HIV testing at a paediatric clinic following presentation with AIDS-related symptoms, even if they had not been previously classified as exposed to or infected by HIV and even if their parents had not participated in the Aconda programme. Standardized paediatric follow-upThe Aconda paediatric HIV care package included systematic paediatric HIV testing which varied according to the child's age. In those aged ≥ 18 months, the standard serum testing algorithm comprised a series of two rapid HIV assays: the Determine ® HIV-1/2 assay (Inverness Medical, Bedford, United Kingdom of Great Britain and Northern Ireland) followed by the Genie II ® HIV-1/HIV-2 assay (Bio-Rad laboratories, MarneLa-Coquette, France). 19 Children aged < 18 months were diagnosed virologically using a TaqMan HIV-1, ribonucleic acid (RNA), real-time polymerase chain reaction test (Hoffmann-La Roche, Basel, Switzerland) with a threshold of 300 copies/ml. 20 Children were regarded as having HIV-1 infections if, at any age, they tested positive for HIV-1 RNA in plasma at least once or if, at age ≥ 18 months, they were positive for HIV-1 on serum testing. Children who tested negative but who were still breastfeeding were defined as HIV-undetermined and were retested 2 months after the cessation of breastfeeding or at 18 months. A negative diagnosis was regarded as definite if it was made at least 2 months after the cessation of breastfeeding and children with this diagnosis were excluded from the programme.All children with a confirmed HIV infection were seen monthly and had unrestricted free access to antiretroviral drugs and comprehensive care. 21 In all children, whether on ART or not, the CD4+ T lymphocyte (CD4 cell) count and CD4 cell percentage were measured every 6 months. Plasma viral load testing was not performed routinely after the diagnosis of HIV infection, even in children on ART. Pulmonary radiographs were available for children whose history and symptoms suggested tuberculosis.Children initiated ART if they were either at World Health Organization (WHO) HIV/AIDS clinical stage 3 or 4 or at clinical stage 1 or 2 with impaired immunity (i.e. a CD4 cell percentage ≥ 25 at age < 12 months, ≥ 20 at 12-35 months or ≥ 15 at ≥ 36 month...

show abstract

CD4 Cell Response to Antiretroviral Therapy in Children with Vertically Acquired HIV Infection: Is It Associated with Age at Initiation?

Abstract: We confirm the effectiveness of HAART with respect to the recovery of CD4 cell count and suggest a benefit of initiating ART before the age of 5 months. Age at initiation of the most-potent ART was not associated with the likelihood of sustaining the recovery of CD4 cell count.

Cited by 61 publications

References 26 publications

Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children

Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children

Virological and Immunological Long-Term Outcome of Human Immunodeficiency Virus-1 Infected Children Treated before One Year and after Two Years of Age in a Resource-Limited Setting of South Africa

Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

Contact Info

Product

Resources

About