Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children

作者：Desmonde Sophie^*; Dicko Fatoumata; Koueta Fla; Eboua Tanoh; Balestre Eric; Amani Bosse Clarisse; Aka Edmond A; Lawson Evi Koko; Amorissani Folquet Madeleine; Kouakou Kouadio; Koumakpai Siriatou; Renner Lorna; Sy Haby Signate; Leroy Valeriane

来源：AIDS, 2014, 28(11): 1645-1655.

DOI：10.1097/QAD.0000000000000272

• antiretroviral therapy
• CD4(+) cell
• children
• HIV
• immune reconstitution
• west Africa

Objective: We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4(+) cell response in West African HIV-infected children.
Methods: All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4(+) cell count measurements, including one at ART initiation (baseline) were included. CD4(+) cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4(+) cell count, sex, first-line ART regimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model compared immune recovery for age within 24 months post-ART.
Results: Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4(+) cell gains compared with children less than 2 years, the reference group (P < 0.001). However, by 24 months, we observed higher CD4(+) cell gain in children who initiated ART between 3 and 4 years compared with those less than 2 years (P < 0.001). The 24-month CD4(+) cell gain was also strongest in immunodeficient children at baseline. Among these children, 75% reached immune recovery: 12-month rates were significantly highest in all those aged 2-5 years at ART initiation compared with those less than 2 years. Beyond 12 months on ART, immune recovery was significantly lower in children initiated more than 5 years (adjusted hazard ratio: 0.69, 95% confidence interval: 0.56-0.86).
Conclusion: These results suggest that both the initiation of ART at the earliest age less than 5 years and before any severe immunodeficiency is needed for improving 24-month immune recovery on ART.

• 出版日期2014-7-17