Therapeutic immune reconstitution in HIV-1-infected children is independent of their age and pretreatment immune status.
OBJECTIVE
To evaluate long-term immune reconstitution of children treated with highly active antiretroviral therapy (HAART).


METHODS
The long-term immunological response to HAART was studied in 71 HIV-1-infected children (aged 1 month to 18 years) in two prospective, open, uncontrolled national multicentre studies. Blood samples were taken before and after HAART was initiated, with a follow-up of 96 weeks, and peripheral CD4 and CD8 T cells plus naive and memory subsets were identified in whole blood samples. Relative cell counts were calculated in relation to the median of the age-specific reference.


RESULTS
The absolute CD4 cell count and percentage and the CD4 cell count as a percentage of normal increased significantly (P < 0.001) to medians of 939 x 106 cells/l (range, 10-3520), 32% (range, 1-50) and 84% (range, 1-161), respectively, after 48 weeks. This increase was predominantly owing to naive CD4 T cells. There was a correlation between the increase of absolute naive CD4 T cell counts and age. However, when CD4 T cell restoration was studied as percentage of normal values, the inverse correlation between the increase of naive CD4 T cell count and age was not observed. In addition, no difference in immunological reconstitution was observed at any time point between virological responders and non-responders.


CONCLUSIONS
Normalization of the CD4 cell counts in children treated with HAART is independent of age, indicating that children of all age groups can meet their CD4 T cell production demands. In general, it appears that children restore their CD4 T cell counts better and more rapidly than adults, even in a late stage of HIV-1 infection.
van Rossum
A M
AM
Department of Paediatrics, Sophia Children's Hospital/Erasmus University Medical Centre, 3000 LL Rotterdam, the Netherlands.
Scherpbier
H J
HJ
van Lochem
E G
EG
Pakker
N G
NG
Slieker
W A
WA
Wolthers
K C
KC
Roos
M T
MT
Kuijpers
J H
JH
Hooijkaas
H
H
Hartwig
N G
NG
Geelen
S P
SP
Wolfs
T F
TF
Lange
J M
JM
Miedema
F
F
de Groot
R
R
D000293:Adolescent; D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active; D018106:CD28 Antigens / Q000276:immunology; D017252:CD3 Complex / Q000276:immunology; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000187:drug effects; D002478:Cells, Cultured; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007156:Immunologic Memory; D007223:Infant; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
D000911:Antibodies, Monoclonal; D018106:CD28 Antigens; D017252:CD3 Complex; D012367:RNA, Viral