title: Treatment interruption after 2-year antiretroviral treatment initiated during acute/early HIV in infancy.
abstract: Treatment interruption has been well tolerated and durable in some pediatric studies but none have compared treatment interruption with continued antiretroviral treatment (ART) following ART initiation in early HIV. The objective of this study was to compare outcomes in treatment interruption versus continued ART among early-treated infants.
  
  
  
  Randomized trial (OPH-03; NCT00428116).
  
  
  
  The trial included HIV-infected infants who initiated ART at less than 13 months of age, received ART for 24 months, and, if eligible (CD4% >25%, normal growth), were randomized to treatment interruption versus continued ART. Children in the treatment interruption group restarted ART if they met WHO ART-eligibility criteria. During 18-months postrandomization, primary outcomes were incidence of serious adverse events and growth. CD4%, viral load, morbidity, and growth were compared.
  
  
  
  Of 140 infants enrolled, 121 started ART, of whom 75 completed at least 24 months ART and 42 were randomized (21 per arm). ART was initiated at median age 5 months and randomization at 30 months. Among 21 treatment interruption children, 14 met ART restart criteria within 3 months. Randomization was discontinued by Data and Safety Monitoring Board due to low treatment interruption durability. At 18 months postrandomization, growth and serious adverse events were comparable between arms; hypercholesteremia incidence was higher in the continued arm (P = 0.03). CD4% and viral load did not differ between arms [CD4% 35% and median viral load undetectable (<150 copies/ml) in both arms, P = 0.9 for each comparison]. No infants had post-treatment viral control.
  
  
  
  Short treatment interruption did not compromise 18-month CD4%, viral control, growth, or morbidity compared with continued ART among infants who started ART in early HIV infection.
authors.affiliation: aDepartment of Paediatrics, University of Nairobi, Nairobi, Kenya bDepartment of Global Health cBiostatistics, University of Washington, Seattle, Washington, USA dDepartment of Medical Microbiology, University of Nairobi, Nairobi, Kenya eDepartment of Human Biology, Fred Hutchinson Cancer Research Center fMedicine gPediatrics hEpidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.forename: Sarah
authors.initials: S
authors.lastname: Benki-Nugent
authors.forename: Agnes
authors.initials: A
authors.lastname: Langat
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tapia
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ngugi
authors.forename: Helen
authors.initials: H
authors.lastname: Moraa
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche-Obimbo
authors.forename: Vincent
authors.initials: V
authors.lastname: Otieno
authors.forename: Irene
authors.initials: I
authors.lastname: Inwani
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Bhavna
authors.initials: B
authors.lastname: Chohan
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D028761:Withholding Treatment
chemical_list: D019380:Anti-HIV Agents