TY - JOUR
T1 - Immunologic and virologic responses to HAART in severely immunocompromised HIV-1-infected children
AU - Essajee, Shaffiq M.
AU - Kim, Mimi
AU - Gonzalez, Charles
AU - Rigaud, Mona
AU - Kaul, Aditya
AU - Chandwani, Sulachni
AU - Hoover, William
AU - Lawrence, Robert
AU - Spiegel, Hans
AU - Pollack, Henry
AU - Krasinski, Keith
AU - Borkowsky, William
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1999
Y1 - 1999
N2 - Objective: To determine the long-term immunologic and virologic effects of highly active antiretroviral therapy (HAART) in children with AIDS. Design: A prospective observational study. Setting: Two pediatric HIV clinics. Participants: Twenty-five protease-inhibitor naive HIV-infected children (aged 2-18 years) with advanced disease (CD4 ≤ 6%). Intervention: HAART (one protease inhibitor and one or more nucleoside analogs). Diphtheria and tetanus immunization in six patients after 18 months of therapy. Main outcome measures: Changes in percentage of CD4 cells and plasma HIV-1 RNA levels; post-treatment assays of lymphoproliferative responses to recall antigens; CD4 cell memory phenotype. Results: Median duration of follow-up was 18.8 months (range, 7.5-28 months). At baseline the CD4 cell percentage was 2% (range, 0-6%), this increased significantly to 16% (range, 3-48%) above baseline at 12 months (P = 0.002). The mean maximum CD4 cell increase was 20.7% (range 4-48%) which corresponds to 657 x 106 cells/l (range, 30-2240 x 106 cells/l) above baseline. By contrast, the median viral load was not significantly lower at 12 months than at baseline (P = 0.34), and only 25% of the patients had sustained undetectable viral load. Of the reconstituted CD4 cells 70% were naive, and none of the subjects had lymphoproliferative responses to tetanus and diphtheria although 40% did develop responses to Candida, an environmental antigen. A single immunization with diphtheria and tetanus toxoid produced lymphoproliferative responses to tetanus in three out of six patients. Conclusions: HAART was associated with sustained increases in CD4 cell counts, despite a high incidence of 'virologic failure'. CD4 counts and the proportion of naive cells were higher than have been reported in adults, which may be a reflection of greater thymic activity in children. Memory cell clones for antigens encountered in the past which are not prevalent before therapy could not be expanded without additional antigenic exposure.
AB - Objective: To determine the long-term immunologic and virologic effects of highly active antiretroviral therapy (HAART) in children with AIDS. Design: A prospective observational study. Setting: Two pediatric HIV clinics. Participants: Twenty-five protease-inhibitor naive HIV-infected children (aged 2-18 years) with advanced disease (CD4 ≤ 6%). Intervention: HAART (one protease inhibitor and one or more nucleoside analogs). Diphtheria and tetanus immunization in six patients after 18 months of therapy. Main outcome measures: Changes in percentage of CD4 cells and plasma HIV-1 RNA levels; post-treatment assays of lymphoproliferative responses to recall antigens; CD4 cell memory phenotype. Results: Median duration of follow-up was 18.8 months (range, 7.5-28 months). At baseline the CD4 cell percentage was 2% (range, 0-6%), this increased significantly to 16% (range, 3-48%) above baseline at 12 months (P = 0.002). The mean maximum CD4 cell increase was 20.7% (range 4-48%) which corresponds to 657 x 106 cells/l (range, 30-2240 x 106 cells/l) above baseline. By contrast, the median viral load was not significantly lower at 12 months than at baseline (P = 0.34), and only 25% of the patients had sustained undetectable viral load. Of the reconstituted CD4 cells 70% were naive, and none of the subjects had lymphoproliferative responses to tetanus and diphtheria although 40% did develop responses to Candida, an environmental antigen. A single immunization with diphtheria and tetanus toxoid produced lymphoproliferative responses to tetanus in three out of six patients. Conclusions: HAART was associated with sustained increases in CD4 cell counts, despite a high incidence of 'virologic failure'. CD4 counts and the proportion of naive cells were higher than have been reported in adults, which may be a reflection of greater thymic activity in children. Memory cell clones for antigens encountered in the past which are not prevalent before therapy could not be expanded without additional antigenic exposure.
KW - Highly active antretroviral therapy (HAART)
KW - Pediatric AIDS
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U2 - 10.1097/00002030-199912240-00005
DO - 10.1097/00002030-199912240-00005
M3 - Article
C2 - 10630521
AN - SCOPUS:0033386546
SN - 0269-9370
VL - 13
SP - 2523
EP - 2532
JO - AIDS
JF - AIDS
IS - 18
ER -