Early versus deferred antiretroviral multidrug therapy in infants infected with HIV type 1.
BACKGROUND
The clinical impact of early antiretroviral multidrug therapy on the risk of early-onset severe human immunodeficiency virus (HIV) disease has not been evaluated on a large scale.


METHODS
We evaluated the risk of early-onset events associated with acquired immunodeficiency syndrome (AIDS), particularly the risk of encephalopathy, among infants in the French Perinatal Cohort, according to whether antiretroviral multidrug therapy was initiated before or after the age of 6 months.


RESULTS
Of 83 HIV-infected infants born in 1996 (when HAART became available) or later, 40 received early treatment on or before the age of 6 months, and 43 received deferred multidrug therapy after the age of 6 months. In the group that received early multidrug therapy, no child developed an opportunistic infection or an encephalopathy during the first 24 months of life. In the deferred multidrug therapy group, 6 infants presented with a total of 7 AIDS-associated events (P=.01), 3 of which were encephalopathies (P=.08). The small number of events prevented the identification of clinical and biological markers that accurately predict progression of early-onset severe HIV disease.


CONCLUSIONS
In this observational study, infants who received multidrug therapy before 6 months of age did not have the early-onset severe form of childhood HIV disease. Further studies are needed to find accurate early markers of disease progression in this age group.
Faye
Albert
A
Pédiatrie Générale, Hôpital R. Debré, Paris, France. albert.faye@rdb.ap-hop-paris.fr
Le Chenadec
Jerôme
J
Dollfus
Catherine
C
Thuret
Isabelle
I
Douard
Danièle
D
Firtion
Ghislaine
G
Lachassinne
Eric
E
Levine
Martine
M
Nicolas
Joelle
J
Monpoux
Fabrice
F
Tricoire
Joelle
J
Rouzioux
Christine
C
Tardieu
Marc
M
Mayaux
Marie Jeanne
MJ
Blanche
Stéphane
S
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D007223:Infant; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
D044966:Anti-Retroviral Agents