Antiretroviral Treatment of US Children With Perinatally Acquired HIV Infection: Temporal Changes in Therapy Between 1991 and 2009 and Predictors of Immunologic and Virologic Outcomes
- 1 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in JAIDS Journal of Acquired Immune Deficiency Syndromes
- Vol. 57 (2), 165-173
- https://doi.org/10.1097/qai.0b013e318215c7b1
Abstract
Background: Advances in therapy have allowed children with perinatal HIV infection in the United States to survive into adolescence. We sought to describe the disease status of a large cohort of such children and identify predictors of their current CD4 count and HIV viral load (VL). Methods: The Pediatric HIV/AIDS Cohort Study AMP Protocol is an ongoing prospective study conducted at 15 sites in the United States. Between 2007 and 2009, we enrolled a population-based sample of 451 children with perinatal HIV who were 7-16 years of age at entry. Results: The median age of subjects at entry was 12.2 years, 53% were female, 70% were African-American, and 24% Hispanic. Their median entry CD4% was 33%, and 78% had a CD4% ≥25%; 68% had a suppressed VL. The more recent birth cohorts (1994-2002) had a significantly higher CD4% over time than the earliest birth cohort (1991-1993). The significant independent predictors of a higher CD4% at entry were a suppressed entry VL, a higher nadir CD4%, and starting antiretroviral therapy at a younger age. The mean CD4% at entry for children with a nadir CD4% ≥25% was 9.5% higher than for those with a nadir CD4% P < 0.001). Independent predictors of a suppressed entry VL were membership in a recent birth cohort, male gender, highly active combination antiretroviral therapy use at entry, and fewer prior antiretroviral therapy regimens. Conclusions: Most children with perinatal HIV maintain virologic suppression and good CD4 values. Earlier treatment results in better immune outcome.Keywords
This publication has 28 references indexed in Scilit:
- Growing Up with HIV: Children, Adolescents, and Young Adults with Perinatally Acquired HIV InfectionAnnual Review of Medicine, 2010
- Declines in Mortality Rates and Changes in Causes of Death in HIV-1-Infected Children During the HAART EraJAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
- Antiretroviral Exposure and Lymphocyte mtDNA Content Among Uninfected Infants of HIV-1-Infected WomenPEDIATRICS, 2009
- Incidence of Noninfectious Conditions in Perinatally HIV-Infected Children and Adolescents in The HAART EraArchives of Pediatrics & Adolescent Medicine, 2009
- Toxicities Associated with Dual Nucleoside Reverse‐Transcriptase Inhibitor Regimens in HIV‐Infected ChildrenThe Journal of Infectious Diseases, 2008
- Continuous improvement in the immune system of HIV-infected children on prolonged antiretroviral therapyAIDS, 2008
- Long‐Term Effects of Highly Active Antiretroviral Therapy on CD4+Cell Evolution among Children and Adolescents Infected with HIV: 5 Years and CountingClinical Infectious Diseases, 2008
- Evidence of Ongoing Immune Reconstitution in Subjects with Sustained Viral Suppression following 6 Years of Lopinavir-Ritonavir TreatmentClinical Infectious Diseases, 2007
- Predictors of Adherence to Antiretroviral Medications in Children and Adolescents With HIV InfectionPublished by American Academy of Pediatrics (AAP) ,2006
- Protease Inhibitor Combination Therapy, Severity of Illness, and Quality of Life Among Children With Perinatally Acquired HIV-1 InfectionPEDIATRICS, 2005