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CD4 recovery following antiretroviral treatment interruptions in children and adolescents with HIV infection in Europe and Thailand
Author(s) -
Luisa Galli,
Siobhan Crichton,
Carlotta Buzzoni,
Tessa Goetghebuer,
Gonzague Jourdain,
Ali Judd,
Nigel Klein,
Ma José Mellado,
Ma José Mellado,
Antoni NogueraJulian,
Christian R. Kahlert,
Vana Spoulou,
Henriëtte J. Scherpbier,
Laura Marqués,
IJ Collins,
Diana M. Gibb,
MI González Tome,
MI González Tome,
Josiane Warszawski,
Catherine Dollfus,
Christoph Königs,
Filipa Prata,
Elena Chiappini,
Lars Navér,
Carlo Giaquinto,
Claire Thorne,
Magdalena Marczyńska,
Liubov Okhonskaia,
Thitiporn Borkird,
Pornsawan Attavinijtrakarn,
Ruslan Malyuta,
Alla Volokha,
Luminiţa Ene,
Ruth Goodall
Publication year - 2019
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12745
Subject(s) - medicine , interquartile range , antiretroviral therapy , confidence interval , human immunodeficiency virus (hiv) , viral load , pediatrics , cart , antiretroviral treatment , demography , immunology , mechanical engineering , sociology , engineering
Objectives The aim of the study was to explore factors associated with CD 4 percentage (CD4%) reconstitution following treatment interruptions ( TIs ) of antiretroviral therapy ( ART ). Methods Data from paediatric HIV ‐infected cohorts across 17 countries in Europe and Thailand were pooled. Children on combination ART ( cART ; at least three drugs from at least two classes) for > 6 months before TI of ≥ 30 days while aged < 18 years were included. CD 4% at restart of ART (r‐ ART ) and in the long term (up to 24 months after r‐ ART ) following the first TI was modelled using asymptotic regression. Results In 779 children with at least one TI, the median age at first TI was 10.1 [interquartile range ( IQR ) 6.4, 13.6] years and the mean CD 4% was 27.3% [standard deviation ( SD ) 11.0%]; the median TI duration was 9.0 (IQR 3.5, 22.5) months. In regression analysis, the mean CD 4% was 19.2% [95% confidence interval ( CI ) 18.3, 20.1%] at r‐ ART , and 27.1% (26.2, 27.9%) in the long term, with half this increase in the first 6 months. r‐ ART and long‐term CD 4% values were highest in female patients and in children aged < 3 years at the start of TI . Long‐term CD 4% was highest in those with a TI lasting 1 to <3 months, those with r‐ ART after year 2000 and those with a CD 4% nadir ≥ 25% (all P < 0.001). The effect of CD 4% nadir during the TI differed significantly ( P = 0.038) by viral suppression at the start of the TI ; in children with CD 4% nadir < 15% during TI , recovery was better in those virally suppressed prior to the TI ; viral suppression was not associated with recovery in children with CD 4% nadir ≥ 25%. Conclusions After restart of ART following TI , most children reconstituted well immunologically. Nevertheless, several factors predicted better immunological reconstitution, including younger age and higher nadir CD 4% during TI .