Reduction in Mortality With Availability of Antiretroviral Therapy for Children With Perinatal HIV-1 Infection

Martino, Maurizio de; Tovo, Pier Angelo; Balducci, M; Galli, Luisa; Gabiano, Clara; Rezza, Giovanni; Pezzotti, Patrizio

doi:10.1001/jama.284.2.190

Cited by 328 publications

(202 citation statements)

References 38 publications

(115 reference statements)

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“…Survival of HIV infected children has been analyzed in various cohorts around the world 10,34,35 , demonstrating the impact antiretrovirals have on time and quality of survival, and re-emphasizing the importance of access of all socioeconomic strata to these medications 6,36 .…”

Section: Discussionmentioning

confidence: 99%

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Matida

Ramos

Moncau³

et al. 2007

Cad. Saúde Pública

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Antiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75% of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.

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Section: Discussionmentioning

confidence: 99%

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Matida

Ramos

Moncau³

et al. 2007

Cad. Saúde Pública

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“…Between 7% and 15% of HAART adult patients, however, have a seemingly paradoxical response to HAART in that their CD4 + lymphocytes levels increase substantially but their levels of plasma HIV-1 RNA remain high [ outcome than virological non-responders, the probability of clinical progression is low even in the latter group [33]. HAART is highly effective in reducing the mortality of perinatally infected children [34] despite the fact that the proportion of virological failure is high [19]. The present study has evaluated the in vitro T-lymphocyte function in children with virological failure of HAART.…”

Section: Discussionmentioning

confidence: 99%

Highly active antiretroviral therapy restores in vitro mitogen and antigen-specific T-lymphocyte responses in HIV-1 perinatally infected children despite virological failure

Peruzzi

Azzari

Galli

et al. 2002

Clinical and Experimental Immunology

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SUMMARY To analyse the effect of highly active antiretroviral therapy (HAART) on T-lymphocyte functions we selected seven HIV-1 perinatally infected children (CDC immunological category 1 or 2) who had neither a fall in their plasma HIV-1 RNA levels nor a significant rise in CD4+ lymphocyte counts while receiving HAART. Clinical signs and symptoms were monitored monthly. Plasma viral load, CD4+, CD8+, CD19+ lymphocyte counts and in vitro T-lymphocyte proliferative responses to mitogens (anti-CD3, phytohaemoagglutinin, concanavalin A and pokeweed mitogen) and recall antigens (Candida albicans and tetanus toxoid) were tested at baseline and after 1, 3, 6 and 12 months of HAART. Twenty-two healthy age-matched children were studied as controls. A gain in body weight, no worsening of the disease and no recurrence of opportunistic infections were observed. At baseline, the majority of the children had low responses to mitogens, and all of them had a defective in vitro antigen-specific T-lymphocyte response (<2 standard deviations below the mean result for controls). During HAART, a significant increase in the response to mitogens and antigens was observed in all the patients. The T-lymphocyte response was restored more consistently against antigens to which the immune system is constantly exposed (Candida albicans, baseline versus 12 months: P < 0·001) compared with a low-exposure antigen (tetanus toxoid, baseline versus 12 months: P < 0·01). HAART restores in vitro T-lymphocyte responses even in the absence of a significant viral load decrease and despite any significant increase in CD4+ lymphocyte counts. It implies that a direct mechanism might be involved in the overall immune recovery under HAART.

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“…1 Of the 39.5 million people who were estimated to be living with HIV/AIDS in 2006, 2.3 million were children who were younger than 15; more than half a million children died of HIV/AIDS that year. 2 In the West, good outcomes are achieved for children who are on highly active antiretroviral therapy (HAART), [3][4][5][6][7] and studies indicate that similar outcomes can be achieved in resource-limited settings. [8][9][10][11] However, documented experience of treating large numbers of children remains limited.…”

Section: Methods Between June 2003 and March 2005mentioning

confidence: 99%

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Janssens¹,

Raleigh²,

Soeung

et al. 2007

Pediatrics

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OBJECTIVE. Increasing access to highly active antiretroviral therapy to reach all those in need in developing countries (scale up) is slowly expanding to HIV-positive children, but documented experience remains limited. We aimed to describe the clinical, immunologic, and virologic outcomes of pediatric patients with >12 months of highly active antiretroviral therapy in 2 routine programs in Cambodia. METHODS. Between June 2003 and March 2005, 212 children who were younger than 13 years started highly active antiretroviral therapy. Most patients started a standard first-line regimen of lamivudine, stavudine, and nevirapine, using split adult fixed-dosage combinations. CD4 percentage and body weight were monitored routinely. A cross-sectional virologic analysis was conducted in January 2006; genotype resistance testing was performed for patients with a detectable viral load. RESULTS. Mean age of the subjects was 6 years. Median CD4 percentage at baseline was 6. Survival was 92% at 12 months and 91% at 24 months; 13 patients died, and 4 were lost to follow-up. A total of 81% of all patients had an undetectable viral load. Among the patients with a detectable viral load, most mutations were associated with resistance to lamivudine and non–nucleoside reverse-transcriptase inhibitor drugs. Five patients had developed extensive antiretroviral resistance. Being an orphan was found to be a predictor of virologic failure. CONCLUSIONS. This study provides additional evidence of the effectiveness of integrating HIV/AIDS care with highly active antiretroviral therapy for children in a routine setting, with good virologic suppression and immunologic recovery achieved by using split adult fixed-dosage combinations. Viral load monitoring and HIV genotyping are valuable tools for the clinical follow-up of the patients. Orphans should receive careful follow-up and extra support.

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Reduction in Mortality With Availability of Antiretroviral Therapy for Children With Perinatal HIV-1 Infection

Abstract: Survival of perinatally HIV-infected children improved in 1996-1998 as a result of the introduction of combined antiretroviral therapies. JAMA. 2000;284:190-197

Cited by 328 publications

References 38 publications

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Highly active antiretroviral therapy restores in vitro mitogen and antigen-specific T-lymphocyte responses in HIV-1 perinatally infected children despite virological failure

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

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