Impact of long-term viral suppression in CD4+ recovery of HIV-children on Highly Active Antiretroviral Therapy
1 Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid. Spain
2 Servicio de Pediatría-Infecciosas; Hospital Universitario "Virgen de Rocío", Sevilla. Spain
3 Servicio de Pediatría-Infecciosas; Hospital Universitario "Carlos III", Madrid. Spain
4 Servicio de Inmuno-Pediatría; Hospital Universitario "12 de Octubre", Madrid. Spain
5 Servicio de Inmuno-Pediatría; Hospital General Universitario "Gregorio Marañón", Madrid. Spain
6 Servicio de Inmuno-Pediatría; Hospital Universitario "La Paz", Madrid. Spain
7 Servicio de Pediatría-Infecciosas; Hospital Universitario "Niño Jesús". Madrid, Spain
BMC Infectious Diseases 2006, 6:10 doi:10.1186/1471-2334-6-10Published: 24 January 2006
The effects of HAART may differ between children and adults because children have a developing immune system, and the long-term immunological outcome in HIV-infected children on HAART is not well-known. A major aim of our study was to determine CD4+ evolution associated with long-term VL control during 4 years of observation on HAART.
We carried out a retrospective study on a cohort of 160 vertically HIV-infected children. It was carried out from 1996 to 2004 in six large Spanish pediatric referral hospitals. We compared 33 children who had long-term VL suppression (VL ≤400 copies/ml) in the first 12 months of follow-up and maintained that level throughout follow-up (Responders-group), and 127 children with persistently detectable VL in spite of ART switches (Non-Responders-group).
We observed a quick initial and significant increase in CD4+ counts from the baseline to 12 months on HAART in both groups (p < 0.01). The Non-Responders group sustained CD4+ increases and most of these children maintained high CD4+ level counts (≥25%). The Non-Responders group reached a plateau between 26% and 27% CD4+ at the first 12 months of follow-up that remained stable during the following 3 years. However, the Responders group reached a plateau between 30% and 32% CD4+ at 24, 36 and 48 months of follow-up. We found that the Responders group had higher CD4+ count values and higher percentages of children with CD4+ ≥25% than the Non-Responders group (p < 0.05) after month 12.
Long-term VL suppression in turn induces large beneficial effects in immunological responses. However, it is not indispensable to recover CD4+ levels.