CD4 recovery following antiretroviral treatment interruptions in children and adolescents with HIV infection in Europe and Thailand. Issue 7 (16th May 2019)

• Record Type: Journal Article
• Other Names: Galli L investigator.; Crichton S investigator.; Buzzoni C investigator.; Goetghebuer T investigator.; Jourdain G investigator.; Judd A investigator.; Klein N investigator.; José Mellado M investigator.; José Mellado M investigator.; Noguera‐Julian A investigator.; Kahlert C investigator.; Spoulou V investigator.; Scherpbier H investigator.; Marques L investigator.; Collins IJ investigator.; Gibb DM investigator.; González Tome MI investigator.; González Tome MI investigator.; Warszawski J investigator.; Dollfus C investigator.; Königs C investigator.; Prata F investigator.; Chiappini E investigator.; Naver L investigator.; Giaquinto C investigator.; Thorne C investigator.; Marczynska M investigator.; Okhonskaia L investigator.; Borkird T investigator.; Attavinijtrakarn P investigator.; Malyuta R investigator.; Volokha A investigator.; Ene L investigator.; Goodall R investigator.;
• Is Part Of: HIV medicine. Volume 20:Issue 7(2019)
• Page Start: 456
• Page End: 472
• Publication Date: 2019-05-16
• Subjects: antiretroviral therapy -- paediatric -- treatment interruption; HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12745
• Languages: English
• ISSNs: 1464-2662

Abstract

Abstract : Objectives: The aim of the study was to explore factors associated with CD4 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. CD4% 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 CD4% 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 CD4% 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 CD4% values were highest in female patients and in children aged < 3 years at the start of TI. Long‐term CD4% was highest in those with a TI lasting 1 to <3 months, those with r‐ART after year 2000 and those with a CD4% nadir ≥ 25% (all P < 0.001). The effect of CD4% nadir during the TI differed significantly ( P = 0.038) by viral suppression at the start of the TI; in children with CD4% 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 CD4% 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 CD4% during TI.