Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children.
Virologic and immunologic responses to antiretroviral treatment (ART) in infants may differ from older children due to immunologic, clinical, or epidemiologic characteristics.



Longitudinal ART responses were modeled and compared in HIV-infected infants and children enrolled in cohorts in Nairobi, Kenya. Participants were enrolled soon after HIV diagnosis, started on ART, and followed for 2 years. Viral load decline was compared between infant and child cohorts using a nonlinear mixed effects model and CD4% reconstitution using a linear mixed effects model.



Among 121 infants, median age at ART was 3.9 months; among 124 children, median age was 4.8 years. At baseline, viral load was higher among infants than children (6.47 vs. 5.91 log10 copies/ml, P < 0.001). Infants were less likely than children to suppress viral load to less than 250 copies/ml following 6 months of ART (32% infants vs. 73% children, P < 0.0001). CD4% was higher at baseline in infants than children (19 vs. 7.3%, P < 0.001). Older children had more rapid CD4% reconstitution than infants, but failed to catch up to infant CD4%.



Despite substantially higher CD4% at ART initiation, viral suppression was significantly slower among infants than older children. New strategies are needed to optimize infant outcomes on ART.
aDepartment of Epidemiology bDepartment of Biostatistics, University of Washington, Seattle, Washington, USA cDepartment of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya dDepartment of Global Health eDepartment of Microbiology, University of Washington fHuman Biology Division, Fred Hutchinson Cancer Research Center gCenter for AIDS Research Biostatistics Core hDepartment of Medicine iDepartment of Pediatrics, University of Washington, Seattle, Washington, USA.
Kristjana H
KH
Ásbjörnsdóttir
James P
JP
Hughes
Dalton
D
Wamalwa
Agnes
A
Langat
Jennifer A
JA
Slyker
Hellen M
HM
Okinyi
Julie
J
Overbaugh
Sarah
S
Benki-Nugent
Kenneth
K
Tapia
Elizabeth
E
Maleche-Obimbo
Ali
A
Rowhani-Rahbar
Grace
G
John-Stewart
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D000074243:Immune Reconstitution; D007223:Infant; D007630:Kenya; D008297:Male; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D019562:Viral Load
D044966:Anti-Retroviral Agents