Clinical outcomes after an unstructured treatment interruption in children and adolescents with perinatally acquired HIV infection.
OBJECTIVE
An unstructured treatment interruption in children with perinatally acquired HIV infection is an issue with unresolved significance. The objective of this study was to investigate the actual prevalence and clinical outcomes of a treatment interruption in children and adolescents with perinatally acquired HIV-1 infection.


METHODS
Clinical data were analyzed for 72 children and adolescents who had HIV-1 infection and stopped their medications at 4 academic centers in the United States between January 2000 and September 2004.


RESULTS
Among 405 patients with perinatal HIV-1 infection, 72 (17.8%) experienced a treatment interruption during the observation period. The mean age of patients at the time of the treatment interruption was 12.8 years, and the mean length of the treatment interruption was 14 months. Medication fatigue was the most common reason for a treatment interruption. The CD4+ T-cell percentage nadir before the treatment interruption did not predict CD4+ T-cell percentage declines during the treatment interruption; however, the CD4+ T-cell percentage gain from nadir to the time of the treatment interruption predicted CD4+ T-cell percentage declines during the treatment interruption. During the median follow-up of 19 months (range: 6-48 months), 48 (67%) patients resumed antiretroviral medications. As expected, there was a continuous CD4+ T-cell percentage decrease and plasma HIV-1 RNA increase during the observation period. Overall, 7 (10%) patients were admitted to the hospital; 2 (3%) patients experienced an AIDS-defining illness.


CONCLUSIONS
An unstructured treatment interruption seems to be a major issue for youth with perinatally acquired HIV-1 infection. Patients who experienced the greatest rise in CD4+ T-cell percentage on treatment had the largest CD4+ T-cell percentage decline after the treatment interruption. Close monitoring is required when a treatment interruption occurs in children and adolescents with HIV infection.
Saitoh
Akihiko
A
Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0672, USA. asaitoh@ucsd.edu
Foca
Marc
M
Viani
Rolando M
RM
Heffernan-Vacca
Susan
S
Vaida
Florin
F
Lujan-Zilbermann
Jorge
J
Emmanuel
Patricia J
PJ
Deville
Jaime G
JG
Spector
Stephen A
SA
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015704:CD4 Antigens / Q000032:analysis; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000151:congenital* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D019562:Viral Load
D015704:CD4 Antigens