title: CD4+ lymphocyte-based immunologic outcomes of perinatally HIV-infected children during antiretroviral therapy interruption.
abstract: OBJECTIVE
  To assess the characteristics and outcomes of antiretroviral treatment (ART) interruption (TI) in perinatally HIV-infected children.
  
  
  METHODS
  The Adolescent Master Protocol (AMP) of the Pediatric HIV/AIDS Cohort Study is a prospective cohort study that enrolled 7- to 16-year-old perinatally HIV-infected children between 2007 and 2009 from 15 sites in the United States and Puerto Rico.
  
  
  METHODS
  TI was defined as ART discontinuation for ≥ 3 months after ≥ 6 months of continuous ART. Subjects with and without TI were compared. Rates of change (slopes) in CD4 T-lymphocyte (CD4) count and percentage (%) per month during TI were calculated. Factors related to CD4 slope in univariable analyses were included in multivariable linear regression.
  
  
  RESULTS
  Of 444 eligible AMP subjects, 101 (23%) had at least one TI. Subjects with TI were born in earlier years but were otherwise similar to those without TI. For 81 TI subjects with complete data, the median (range) CD4% and CD4 count slopes were -0.66% per month (-3.54% to +1.34% per month) and -12.7 cells per cubic millimeter per month (-148 cells/mm to +31 cells/mm per month), respectively. On multivariable linear regression, there was a trend for lower CD4% slope to be associated (P < 0.1) with female sex, higher CD4% at TI, and higher peak viral load before TI. Advanced HIV disease stage and numerous ART regimens were more common in TI subjects in the lowest (fastest declining) CD4% slope quartile.
  
  
  CONCLUSIONS
  TIs in perinatally HIV-infected youth are common. During TIs, CD4 values decline on average but with high intersubject variability. Factors predicting CD4 slope during TI need further study.
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA. siberryg@mail.nih.gov
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Kunjal
authors.initials: K
authors.lastname: Patel
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Burchett
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Spector
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Andrew
authors.initials: A
authors.lastname: Wiznia
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D011647:Puerto Rico; D016896:Treatment Outcome; D014481:United States
chemical_list: D019380:Anti-HIV Agents