Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Yin, DE; Warshaw, MG; Miller, WC; Castro, H; Fiscus, SA; Harper, LM; Harrison, LJ; Klein, NJ; Lewis, J; Melvin, AJ; Tudor-Williams, G; McKinney, RE; PENPACT-1 (PENTA 9/PACTG 390) Study Team.
Using CD4 percentage and age to optimize pediatric antiretroviral therapy initiation.
Pediatrics. 2014; 134(4): e1104-e1116.
Doi: 10.1542/peds.2014-0527
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- Study Group Mitglieder der Med Uni Graz:
- Warncke Gert
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- Abstract:
- Quantifying pediatric immunologic recovery by highly active antiretroviral therapy (HAART) initiation at different CD4 percentage (CD4%) and age thresholds may inform decisions about timing of treatment initiation. HIV-1-infected, HAART-naive children in Europe and the Americas were followed from 2002 through 2009 in PENPACT-1. Data from 162 vertically infected children, with at least World Health Organization "mild" immunosuppression and CD4% <10th percentile, were analyzed for improvement to a normal CD4% (≥10th percentile) within 4 years after HAART initiation. Data from 209 vertically infected children, regardless of immune status, were analyzed for CD4% outcomes at 4 years and viral failure within 4 years. Seventy-two percent of baseline immunosuppressed children recovered to normal within 4 years. Compared with "severe" immunosuppression, more children with "mild" immunosuppression (difference 36%, 95% confidence interval [CI]: 22% to 49%) or "advanced" immunosuppression (difference 20.8%, 95% CI: 5.8% to 35.9%) recovered a normal CD4%. For each 5-year increase in baseline age, the proportion of children achieving a normal CD4% declined by 19% (95% CI: 11% to 27%). Combining baseline CD4% and age effects resulted in >90% recovery when initiating HAART with "mild" immunosuppression at any age or "advanced" immunosuppression at age <3 years. Baseline CD4% effects became greater with increasing age (P = .02). At 4 years, most immunologic benefits were still significant but diminished. Viral failure was highest in infancy (56%) and adolescence (63%). Initiating HAART at higher CD4% and younger ages maximizes potential for immunologic recovery. Guidelines should weigh immunologic benefits against long-term risks. Copyright © 2014 by the American Academy of Pediatrics.
- Find related publications in this database (using NLM MeSH Indexing)
- Adolescent -
- Anti-HIV Agents - administration & dosage
- Antiretroviral Therapy, Highly Active - standards
- CD4 Lymphocyte Count - methods
- CD4-Positive T-Lymphocytes - drug effects
- CD4-Positive T-Lymphocytes - immunology
- Child -
- Child, Preschool -
- Female -
- Follow-Up Studies -
- HIV Infections - drug therapy
- HIV Infections - epidemiology
- HIV Infections - immunology
- HIV-1 - drug effects
- HIV-1 - physiology
- Humans -
- Infant -
- Infant, Newborn -
- Male -
- Find related publications in this database (Keywords)
- child
- HIV
- immunologic
- reconstitution
- treatment failure