Predictive Value of Quantitative Plasma HIV RNA and CD4+ Lymphocyte Count in HIV-Infected Infants and Children

Abstract

THE TREATMENT of human immunodeficiency virus (HIV) infection with antiretroviral compounds has recently undergone rapid progress. In parallel, the quantitation of plasma viral RNA and CD4⁺ lymphocytes has become the foundation on which prediction of clinical course and response to therapy is based. Most of this rapid change has resulted from clinical studies conducted in adult populations. Aggressive, multidrug regimens are currently being introduced into pediatric populations both in clinical practice as well as in controlled trials.^1-4 While plasma RNA and CD4⁺ lymphocyte quantitation data are being generated in children, it is unclear whether the experience and guidelines developed for adults^5-7 will be applicable to infants and children. Special issues that underscore this concern include the presence of a developing immune system at the time of infection followed by high levels of proliferating target cells and immune activation^8,9 and persistently high levels of plasma virus for extended periods in young children.^10-12