Document Detail


Early antiretroviral therapy in HIV-1-infected infants, 1996-2008: treatment response and duration of first-line regimens.
MedLine Citation:
PMID:  21971357     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate virological and immunological response to antiretroviral therapy (ART), and predictors of switching and interrupting treatment among infants starting ART across Europe.
DESIGN: Cohort study.
METHODS: Nine cohorts from 13 European countries contributed data on HIV-infected infants born 1996-2008 and starting ART before age 12 months. Logistic and linear regression, and competing risks methods were used to assess predictors of virological (viral load <400 copies/ml) and immunological (change in CD4 Z-score) response, switching to second-line ART and treatment interruptions with viral load less than 400 copies/ml.
RESULTS: A total of 437 infants were followed for median 5.9 (interquartile range 2.3-7.6) years after starting ART; 30% had an AIDS diagnosis prior to ART initiation. 53% had suppressed viral load <400 copies/ml at 12 months in 1996-1999, increasing to 77% in 2004-2008. Virological and immunological responses at 12 months varied by initial ART type (P < 0.001 and P = 0.03, respectively), with four-drug nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens being superior [virological response <400 copies/ml adjusted odds ratio = 3.00, 95% confidence interval (CI) 1.24-7.23; mean increase in CD4 Z-score coefficient = 0.64, 95% CI 0.10-1.17] to both three-drug NNRTI-based (reference) and boosted protease inhibitor regimens which were similar. Rates of switching to second-line ART were lower among children starting four-drug NNRTI-based and boosted protease inhibitor-based regimens compared with three-drug NNRTI regimens (P = 0.03). Sixty five percent of infants remained on first-line ART without treatment interruption after 5 years.
CONCLUSION: Effective and prolonged responses to first-line ART can now be achieved in infants starting early ART outside trial settings. Superior responses to four-drug NNRTI compared with boosted protease inhibitor or three-drug NNRTI regimens need further evaluation, as does treatment interruption following early ART.
Authors:
Ali Judd;
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  AIDS (London, England)     Volume:  25     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-09     Completed Date:  2012-01-31     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  2279-87     Citation Subset:  IM; X    
Copyright Information:
2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / drug therapy
CD4 Lymphocyte Count
Cohort Studies
Drug Therapy, Combination / methods
Europe
Female
HIV Infections / drug therapy*,  immunology,  virology
HIV Protease Inhibitors / administration & dosage*
Humans
Infant
Infant, Newborn
Male
Reverse Transcriptase Inhibitors / administration & dosage*
Treatment Outcome
Viral Load
Grant Support
ID/Acronym/Agency:
081082//Wellcome Trust; MC_U122886353//Medical Research Council
Chemical
Reg. No./Substance:
0/HIV Protease Inhibitors; 0/Reverse Transcriptase Inhibitors
Investigator
Investigator/Affiliation:
Ali Judd / ; Martina Penazzato / ; Claire Townsend / ; Trinh Duong / ; Hannah Castro / ; Tessa Goetghebuer / ; Josiane Warszawski / ; Luisa Galli / ; Elena Chiappini / ; Maurizio de Martino / ; Luminita Ene / ; Carlo Giaquinto / ; Christoph Königs / ; Jerome LeChenadec / ; Hermione Lyall / ; Antoni Noguera Julian / ; Jose T Ramos / ; Pablo Rojo-Conejo / ; Christoph Rudin / ; Claire Thorne / ; Pat Tookey / ; Gareth Tudor-Williams / ; Di M Gibb /
Comments/Corrections

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