Long-term nonprogression of HIV infection in children: evaluation of the ANRS prospective French Pediatric Cohort.
BACKGROUND
Some children who are infected with human immunodeficiency virus type 1 (HIV-1) during the perinatal period remain asymptomatic for very long periods in the absence of antiretroviral treatment, as is the case for some adults. Our objective was to estimate the proportion of children who developed neither symptoms nor major immunological perturbations to the age of > or = 10 years in a prospective cohort of infected children who had been observed since birth.


METHODS
The ongoing prospective French Pediatric Cohort includes 568 HIV-1-infected children. Here, we report the follow-up data for all 348 HIV-1-infected children who were born before 1 January 1994. Children with long-term nonprogression of infection (LTNPs) were defined as HIV-1-infected children who had been observed for at least 10 years, never received antiretroviral treatment other than zidovudine monotherapy, never developed symptoms of Centers for Disease Control and Prevention clinical category C or B, and had a CD4+ cell percentage of < 25% no more than once during follow-up. Other definitions were compared.


RESULTS
The Kaplan-Meier estimate of long-term nonprogression was 2.4% (95% confidence interval, 1.1%-4.6%) at 10 years of age, and 7 children were classified as LTNPs. The Kaplan-Meier estimates decreased slightly with age, to 1.8% at 12 years of age and 1.4% at 14 years of age. Plasma HIV-1 replication rates were low (< 1000 copies RNA/mL) for 2 of the 7 LTNPs at the age of 10 years (0.6% of the total denominator). None of the routinely measured maternal or perinatal markers were significantly linked to long-term nonprogression, with the exception of the mother's Centers for Disease Control and Prevention clinical category at the time of delivery.


CONCLUSIONS
Approximately 2% of children who were infected during the perinatal period displayed no immunological or clinical progression by the age of 10 years. This figure is close to that reported for adults in studies that have used similar definitions.
Warszawski
Josiane
J
Institut National de la Santé et de la Recherche Medicale U822, France.
Lechenadec
Jérôme
J
Faye
Albert
A
Dollfus
Catherine
C
Firtion
Ghislaine
G
Meyer
Laurence
L
Douard
Danielle
D
Monpoux
Fabrice
F
Tricoire
Joëlle
J
Benmebarek
Yassine
Y
Rouzioux
Christine
C
Blanche
Stéphane
S
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D015497:HIV-1; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D013997:Time Factors; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine