title: Frequent Episodes of Detectable Viremia in HIV Treatment-Experienced Children is Associated with a Decline in CD4+ T-cells Over Time.
abstract: BACKGROUND
  The clinical consequences of the magnitude and the duration of detectable viremia in HIV-infected children have not been well characterized. We examined the predictors and immunologic consequences over time of frequent episodes of detectable viremia in HIV-infected children followed at Yale-New Haven Hospital.
  
  
  METHODS
  We analyzed the CD4+ T-cell and HIV viral load over a 19-year period (1996 to 2013) of 104 HIV-infected children enrolled in the Yale Prospective Longitudinal Pediatric HIV Cohort. Both CD4+ T-lymphocytes and HIV viral load were measured at clinic visits every 3 to 4 months. Longitudinal data analyses using polynomial random coefficients models were conducted to examine overtime changes in CD4+ T-cell counts by frequency of episodes of detectable viremia. Moreover, regression analyses using logistic regression models were used to assess the predictors of frequent episodes of detectable viremia.
  
  
  RESULTS
  One hundred and four (104) HIV-infected children with more than one HIV viral load measurement between 1996 and November 2013 were included in the analysis. Over 80% (N=86) of the children had detectable viral load (HIV RNA viral load ≥50 copies/ml) during more than 50% of their clinic visits. Children with infrequent episodes of detectable viremia had significantly higher CD4+ T-cell counts overtime compared to those with frequent episodes of detectable viremia (P<0.0001).
  
  
  CONCLUSIONS
  Both frequency and magnitude of episodes of detectable viremia had effect on CD4+ T-cells. Strict adherence to a treatment goal of undetectable HIV viremia in children is likely to be beneficial.
authors.affiliation: Departments of Pediatrics and Pharmacology, Yale University School of Medicine, New Haven, USA.
authors.forename: Elijah
authors.initials: E
authors.lastname: Paintsil
authors.affiliation: Georgetown University, Washington, DC, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Martin
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Goldenthal
authors.affiliation: Tufts University, Medford, USA.
authors.forename: Shreya
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, USA.
authors.forename: Warren
authors.initials: W
authors.lastname: Andiman
authors.affiliation: Ragon Institute and Harvard Medical School, Cambridge, MA.
authors.forename: Musie
authors.initials: M
authors.lastname: Ghebremichael
keywords: CD4+ T-Cell; HIV-infected children; Transient viremia; Viral blips; Virologic failure