Low Risk of CD4 Decline After Immune Recovery in Human Immunodeficiency Virus-Infected Children With Viral Suppression.
Regular CD4 count testing is often used to monitor antiretroviral therapy efficacy. However, this practice may be redundant in children with a suppressed human immunodeficiency virus (HIV) viral load.


METHODS
Study end points were as follows: (1) a CD4 count <200 cells/mm3 followed by a CD4 count ≥200 cells/mm3 (transient CD4 <200); (2) CD4 count <200 cells/mm3 confirmed within 6 months (confirmed CD4 <200); and (3) a new or recurrent World Health Organization (WHO) stage 3 or 4 illness (clinical failure). Kaplan-Meier curves and Cox regression were used to evaluate rates and predictors of transient CD4 <200, confirmed CD4 <200, and clinical failure among virally suppressed children aged 5-15 years who were enrolled in the TREAT Asia Pediatric HIV Observational Database.


RESULTS
Data from 967 children were included in the analysis. At the time of confirmed viral suppression, median age was 10.2 years, 50.4% of children were female, and 95.4% were perinatally infected with HIV. Median CD4 cell count was 837 cells/mm3, and 54.8% of children were classified as having WHO stage 3 or 4 disease. In total, 18 transient CD4 <200 events, 2 confirmed CD4 <200 events, and10 clinical failures occurred at rates of 0.73 (95% confidence interval [95% CI], 0.46-1.16), 0.08 (95% CI, 0.02-0.32), and 0.40 (95% CI, 0.22-0.75) events per 100 patient-years, respectively. CD4 <500 cells/mm3 at the time of viral suppression confirmation was associated with higher rates of both CD4 outcomes.


CONCLUSIONS
Regular CD4 testing may be unnecessary for virally suppressed children aged 5-15 years with CD4 ≥500 cells/mm3.
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand.
Pope
P
Kosalaraksa
The Kirby Institute, University of New South Wales Australia, Sydney.
David C
DC
Boettiger
HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, and.
Torsak
T
Bunupuradah
Chiangrai Prachanukroh Hospital, Thailand.
Rawiwan
R
Hansudewechakul
University of Health Sciences, Phnom Penh, Cambodia.
Sarun
S
Saramony
Children's Hospital 2, Ho Chi Minh City, Vietnam.
Viet C
VC
Do
Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Thailand.
Tavitiya
T
Sudjaritruk
Hospital Raja Perempuan Zainab II, Kelantan, and.
Nik K N
NKN
Yusoff
Pediatric Institute, Hospital Kuala Lumpur, Malaysia.
Kamarul A M
KAM
Razali
National Hospital of Pediatrics, Hanoi, Vietnam.
Lam V
LV
Nguyen
Penang Hospital, and.
Revathy
R
Nallusamy
Hospital Likas, Kota Kinabalu, Malaysia.
Siew M
SM
Fong
Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Nia
N
Kurniati
Children's Hospital 1, Ho Chi Minh City, Vietnam.
Khanh H
KH
Truong
TREAT Asia/amfAR, The Foundation for AIDS Research, and.
Annette H
AH
Sohn
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Kulkanya
K
Chokephaibulkit
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents
CD4 cell count monitoring; pediatrics; viral suppression.