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Advances In Antiretroviral Therapy Have Improved Outcomes For Children With HIV

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Published: Apr 26, 2011 4:40 pm
Advances In Antiretroviral Therapy Have Improved Outcomes For Children With HIV

Results from a recent study indicate that advances in antiretroviral therapy over the last 15 years have considerably improved outcomes for children with HIV who are entering adolescence and young adulthood.

The study found that most children with HIV maintain viral suppression and high CD4 (white blood) cell counts despite having had extensive treatment. Starting treatment earlier was more likely to result in better outcomes.

The researchers stated that their results support current U.S. treatment guidelines for initiating therapy at higher CD4 percentages in children.

Dr. Russell Van Dyke, co-author of the study and an infectious diseases expert at Tulane University, stated in a press release that while children with HIV “are still infected and not cured, it’s surprising how well they’re doing considering what they’ve been through.”

“They’re going to school and doing all of the things that kids should do. Hopefully they will be living 50 or 60 years or more, so what’s going to happen 40 years from now is the real concern,” said Dr. Van Dyke.

Dr. Van Dyke noted that as HIV becomes a more chronic, treatable disease, clinicians are starting to focus more on solving long-term complications, such as coronary artery disease and neurological and cognitive problems that might occur in children born with HIV.

“We’re not seeing the deaths we used to see due to infections, but we’re starting to worry about longer-term complications. Some of these complications may be related to the HIV itself, or some may be related to the medications these kids are on,” he said.

However, he stated that he expects many of the children in the study to have a normal or almost normal life span.

Today, fewer than 250 children are born with HIV each year in the United States. Most children with HIV were born before the advent of highly active antiretroviral therapy (HAART) in 1996. When taken during pregnancy and childbirth, HAART reduces the chances of a mother passing HIV to her child from 25 to 30 percent to less than 2 percent.

Since HAART is associated with better viral control, fewer HIV-related illnesses, improved survival, and an improved quality of life in most children, researchers hypothesized that children born with HIV more recently may have better outcomes than children born before 1996.

In their study, the researchers analyzed data from 451 children born with HIV in the U.S. between 1991 and 2002. The average age of study participants was 12 years. Most of the children (70 percent) were African American, and most of the rest (24 percent) were Hispanic. Slightly more than half (53 percent) were female.

The researchers divided the children into four groups depending on when they were born (1991 to 1993, 1994 to 1995, 1996 to 1997, and 1998 to 2002) to account for changes in the availability and use of antiretrovirals over time.

Researchers measured the children’s CD4 cell percentages (the fraction of their white blood cells that are CD4 cells, the cells targeted by HIV) and viral loads (amount of HIV in the blood) at the time they enrolled in the study. CD4 cell percentages, rather than CD4 counts, were used because these vary less by age in young children; normal CD4 cell percentages should be above 25 percent.

They also analyzed the children’s treatment and medical histories, including when they started treatment and how many different antiretroviral drugs they had taken. Most of the children (86 percent) were receiving a HAART regimen at the start of the study, with 70 percent taking a protease inhibitor-based regimen and 16 percent taking a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. The rest were not taking HAART.

Results showed that the average CD4 percentage for participants was 33 percent; the majority of children (78 percent) had normal CD4 percentages of at least 25 percent.

In addition, 68 percent of the children had achieved viral suppression, defined in this study as less than 400 copies of the virus per milliliter of blood.

Further analysis showed that children who began antiretroviral therapy at a younger age, had achieved viral suppression, and had a higher nadir CD4 percentage were more likely to have a higher CD4 percentage. The nadir CD4 percentage is defined as the lowest CD4 percentage measured after HIV infection.

Children who had fewer previous treatment regimens, received HAART, and had been born in 1996 or later were more likely to have achieved viral suppression at the start of the study. Boys were also slightly more likely than girls to have achieved viral suppression.

Children who were taking HAART at the start of the study had an 80 percent lower risk of having a detectable viral load than children not receiving HAART. There were no differences between protease inhibitor-based regimens versus NNRTI-based regimens.

Results also showed that most of the children were highly treatment experienced. Study participants had taken a median of seven different antiretrovirals and five different treatment regimens, with a median of 11.4 years of antiretroviral treatment total.

For every additional regimen taken prior to enrolling in the study, the researchers found a 10 percent increase in the risk of a child having a detectable viral load at the start of the study.

The outcomes of the children varied depending on when they were born. Children born more recently began treatment at an earlier age, were more likely to have received HAART as their initial regimen, and had received fewer total treatment regimens.

They also had maintained higher average CD4 percentages throughout their lifetimes than participants born earlier and were less likely to have been diagnosed with AIDS.

The researchers stated that further studies are needed to investigate the modest association between gender and viral response in children. A study is also underway to assess the effects of viral resistance on treatment failure in children.

For more information, please see the study in the Journal of Acquired Immune Deficiency Syndromes (abstract) or the press release from Tulane University.

Photo by Garry Knight on Flickr – some rights reserved.
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