Treatment interruption in children with HIV infection.
OBJECTIVE
To review studies evaluating the role of planned/structured treatment interruptions in the management of HIV-infected children.


RESULTS
Randomized controlled treatment interruption trials in adults have reported varying results. Three trials were stopped early by their data safety and monitoring boards because of inferiority of the interruption arm, based on differences in the risk of clinical events between randomized arms. Although the risk in the treatment interruption arms relative to continuous treatment was substantial, the absolute risks of AIDS/death were low in both arms. Little research has been carried out evaluating treatment interruptions in children, even though their role may be more critical as children frequently start antiretroviral therapy at an early age with the expectation that they will need to take it for life.


CONCLUSIONS
In addition to observational studies, two ongoing randomized paediatric trials in chronic infection are based on CD4-guided treatment interruption strategies, using higher CD4 thresholds for restart/stop of antiretroviral therapy than in adult trials. Three trials are evaluating strategies of interruption following treatment of primary infection in infancy. It is vital that this research continues as antiretroviral therapy is rolled out to increasing numbers of young children in resource-limited settings.
Medical Research Council Clinical Trials Unit, London, UK. hjg@ctu.mrc.ac.uk
Hannah
H
Green
Diana M
DM
Gibb