[Highly active antiretroviral therapy in HIV sero-positive children. Disease progression by baseline clinical, immunological and virological status].
BACKGROUND
Highly active antiretroviral therapy (HAART) has been administered to children infected with human immunodeficiency virus (HIV) since 1996. This kind of therapy is effective in achieving viral suppression and stopping disease progression but prolonged administration increases the risk of toxic effects, favours the onset of viral resistance and leads to decreased adherence. The aim of the present study was to determine prognostic factors among clinical, immunological and virological parameters at the beginning of HAART.


METHODS
We performed a prospective-retrospective observational analysis of a cohort or 564 HIV+ children assisted in Hospitals of Buenos Aires and Rosario, Argentina, treated with HAART since 1998 (media of treatment: 46.78 months. Range: 2-91 months). Patients were divided in groups according to age (younger or older than one year), and outcome (favourable or unfavourable). Stage, CD4 lymphocytes percentage, CD4 lymphocyte cell count and viral load at the beginning of treatment were analyzed with outcome by means of chi(2) tests, and logistic regression.


RESULTS
No differences were observed on the percentage of CD4 T cells and viral load at baseline, between children under one year of age with good (n= 79) or bad outcomes (n= 4). Among older children (450 with good outcome, 31 with unfavourable), the following were identified as predictors of bad outcome: HAART initiation during stage C (p= 0.006), CD4 T-cell percentage below 15 percent (p< 0.001) and CD4 absolute value below 500 cells/mm(3) (p= 0.003).


CONCLUSIONS
Children older than one year will have better outcome when HAART is initiated before stage C, with more than 15% CD4 or more than 500 cells/mm(3).
Rodríguez de Schiavi
M Susana
MS
Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan. mrodriguez@garrahan.gov.ar
Scrigni
Adriana
A
García Arrigoni
Patricia
P
Bologna
Rosa
R
Barboni
Graciela
G
Redondo
Julia
J
Nastri
Mariana
M
Mecikovsky
Débora
D
Cantisano
Claudio
C
Moreno
Rina
R
Siciliani
Darío
D
Lencina
Mónica
M
Luedicke
Nora
N
Rezzónico
Gabriela
G
Torolla
José L
JL
López Papucci
Santiago
S
Luis
Miguel
M
Libonati
Carmen
C
Gamba
Luis
L
Barbarysky
Jeanette
J
Pérez Hernández
Ema
E
Zlatkes
Rafael
R
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies