Long-term survival and immuno-virological response of African HIV-1-infected children to highly active antiretroviral therapy regimens.
BACKGROUND
In Africa, facing the scaling-up of HAART, there is an urgent need to monitor accurately the long-term benefits of these lifelong treatments.


METHODS
Survival and immuno-virological response were assessed for 78 children in the ANRS 1244/1278 Children's cohort (Abidjan, Côte d'Ivoire) who were enrolled from October 2000 for treatment with HAART and followed to September 2004. Initial HAART consisted of two nucleoside reverse transcriptase inhibitors with either nelfinavir (NFV) or efavirenz (EFV). For the comparison of immunological and virological responses, CD4 cell counts and HIV-1 RNA viral load were assessed by performing time-point specific and longitudinal data analysis.


RESULTS
At baseline, the median CD4 cell percentage was 7.5% and the median HIV-1 RNA viral load was 5.37 log10 copies/ml. The survival probability was high (0.86 at month 42; 95% confidence interval, 0.77-0.92) with no difference according to whether the HAART regimen contained NFV or EFV. At 36 and 42 months of follow-up, an immune recovery was observed with median CD4 cell percentages reaching 23.1% and 24.8%, respectively, with no difference according to the HAART regimen (longitudinal data analysis). At the same time points, a sustained viral suppression was also obtained, with undetectable viral load achieving in 46.5% and 45.0%, respectively, regardless of whether the HAART regimen.


CONCLUSIONS
This study demonstrates the durability of both clinical and biological response to HAART in African children.
Rouet
François
F
Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), CHU de Treichville, Côte d'Ivoire. franrouet@yahoo.fr
Fassinou
Patricia
P
Inwoley
André
A
Anaky
Marie-France
MF
Kouakoussui
Alain
A
Rouzioux
Christine
C
Blanche
Stéphane
S
Msellati
Philippe
P
D000293:Adolescent; D000480:Alkynes; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D048588:Benzoxazines; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D007560:Cote d'Ivoire / Q000453:epidemiology; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D019888:Nelfinavir / Q000627:therapeutic use; D010078:Oxazines / Q000627:therapeutic use; D012367:RNA, Viral / Q000276:immunology; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D010078:Oxazines; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019888:Nelfinavir; C098320:efavirenz