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

作者：A**jornsdottir Kristjana H^*; Hughes James P; Wamalwa Dalton; Langat Agnes; Slyker Jennifer A; Okinyi Hellen M; Overbaugh Julie; Benki Nugent Sarah; Tapia Kenneth; Maleche Obimbo Elizabeth; Rowhani Rahbar Ali; John Stewart Grace

来源：AIDS, 2016, 30(18): 2835-2843.

DOI：10.1097/QAD.0000000000001244

• antiretroviral therapy
• CD4(+) reconstitution
• HIV viral load suppression
• HIV-infected children
• HIV-infected infants
• pediatric HIV

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 2 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 was higher among infants than children (6.47 vs. 5.91 log(10) copies/ml, P < 0.001). Infants were less likely than children to suppress viral load to less than 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.

• 出版日期2016-11-28