Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy.
BACKGROUND
Early highly active antiretroviral therapy (HAART), started within the first months of age, has been proven to be the optimal strategy to prevent immunological and clinical deterioration in perinatally HIV-infected children. Nevertheless, data about long-term follow-up of early treated children are lacking.


METHODS
We report data from 40 perinatally HIV-infected-children receiving early HAART, with a median follow-up period of 5.96 years (interquartile range [IQR]:4.21-7.62). Children were enrolled at birth in the Italian Register for HIV Infection in Children. Comparison with 91 infected children born in the same period, followed-up from birth, and receiving deferred treatment was also provided.


RESULTS
Nineteen children (47.5%) were still receiving their first HAART regimen at last follow-up. In the remaining children the first regimen was discontinued, after a median period of 3.77 years (IQR: 1.71-5.71) because of viral failure (8 cases), liver toxicity (1 case), structured therapy interruption (3 cases), or simplification/switch to a PI-sparing regimen (9 cases). Thirty-nine (97.5%) children showed CD4+ T-lymphocyte values>25%, and undetectable viral load was reached in 31 (77.5%) children at last visit. Early treated children displayed significantly lower viral load than not-early treated children, until 6 years of age, and higher median CD4+ T-lymphocyte percentages until 4 years of age. Twenty-seven (29.7%) not-early treated vs. 0/40 early treated children were in clinical category C at last follow-up (P < 0.0001).


CONCLUSIONS
Our findings suggest that clinical, virologic and immunological advantages from early-HAART are long-lasting. Recommendations indicating the long-term management of early treated children are needed.
Chiappini
Elena
E
Department of Pediatrics, University of Florence, Florence, Italy. echiappini@unifi.it
Galli
Luisa
L
Tovo
Pier-Angelo
PA
Gabiano
Clara
C
Lisi
Catiuscia
C
Bernardi
Stefania
S
Viganò
Alessandra
A
Guarino
Alfredo
A
Giaquinto
Carlo
C
Esposito
Susanna
S
Badolato
Raffaele
R
Di Bari
Cesare
C
Rosso
Raffaella
R
Genovese
Orazio
O
Masi
Massimo
M
Mazza
Antonio
A
de Martino
Maurizio
M
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007223:Infant; D007558:Italy; D012367:RNA, Viral / Q000032:analysis; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral