Transient viral load increases in HIV-infected children in the U.K. and Ireland: what do they mean?
OBJECTIVE
To investigate transient increases in viral load during sustained suppression in children in the UK and Ireland Collaborative HIV Paediatric Study (CHIPS).


METHODS
Cohort of HIV-infected children from 39 centres.


METHODS
Transient viraemia was defined as > or =1 detectable viral loads (> or =50 copies/ml) between two undetectable values (<50 copies/ml) <280 days apart, during a period of sustained viral suppression (from a confirmed level of <50 copies/ml until the last undetectectable measurement before antiretroviral therapy change or until a confirmed level of >50 copies/ml).


RESULTS
Of 595 children initiating HAART without previous treatment, 347 (58%) achieved sustained suppression. Of these, 78 (23%) experienced 109 episodes of transient viraemia (median 134 copies/ml); 92 (84%) had levels of <1000 copies/ml (maximum 39,839). Transient viraemia was more common during second-line therapy (25/100 child-years [CY]) and following a previous episode (19/100 CY) compared with first-line therapy without a previous episode (11/100 CY). Rates decreased with age at HAART initiation (incidence rate ratio [IRR] 0.95 per year older; P = 0.05), but were higher in those suppressed for longer (IRR 1.63 in those suppressed for 21 year versus <1 year; P = 0.03). CD4+ and CD8+ T-cell counts were similar before and after transient viraemia. Of detectable viral loads during periods of suppression 44% were transient increases rather than virological failure: experiencing transient viraemia did not increase subsequent virological failure (P = 0.20).


CONCLUSIONS
Transient viraemia is relatively common among children on HAART, occurring more frequently in those starting HAART at younger ages, on second-line therapy and after longer suppression. It does not appear to affect CD4+ or CD8+ T-cell counts or the risk of subsequent virological failure. Natural variation, assay effects and adherence might all have a role.
Lee
Katherine J
KJ
MRC Clinical Trials Unit, London, UK. kjl@ctu.mrc.ac.uk
Shingadia
Delane
D
Pillay
Deenan
D
Walker
A Sarah
AS
Riordan
Andrew
A
Menson
Esse
E
Duong
Trinh
T
Tudor-Williams
Gareth
G
Gibb
Diana M
DM
D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D006678:HIV / Q000187:drug effects / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D007223:Infant; D007494:Ireland; D008297:Male; D006113:United Kingdom; D019562:Viral Load; D014766:Viremia
D019380:Anti-HIV Agents