CD4 Cell Response to Antiretroviral Therapy in Children with Vertically Acquired HIV Infection: Is It Associated with Age at Initiation?
Background.
Considerable uncertainty remains as to whether early initiation of antiretroviral therapy (ART) in children with vertically acquired human immunodeficiency virus (HIV) infection increases the benefit in terms of immunological response.
Methods.The association between immunological outcome and early initiation of and/or more‐potent ART was investigated, using age‐standardized z scores for CD4 cell counts (hereafter, “CD4 z scores”), in 131 HIV‐infected children enrolled in the European Collaborative Study, a birth cohort study.
Results.Median age at initiation of the most‐potent ART was 4 years (range, 0.1–15.5 years). Initiation of treatment after 5 months of age resulted in nonsignificantly lower CD4 z scores 6 months after initiation. Time to a 20% increase in CD4 z score was associated with age at initiation of the most‐potent ART (adjusted hazard ratios [AHRs], 0.37 [
] and 0.43 [
] for 5 months–5 years of age and >5 years of age, respectively, compared with <5 months of age), ethnicity (AHR, 0.48 [
], for black vs. white), and highly active ART (HAART) with or without prior ART (AHRs, 3.16 [
] and 3.95 [
], vs. mono or dual ART, respectively). The risk of subsequent deterioration of CD4 z score was similar for children who initiated ART in different age groups (
; 
).
Conclusions.We confirm the effectiveness of HAART with respect to the recovery of CD4 cell count and suggest a benefit of initiating ART before the age of 5 months. Age at initiation of the most‐potent ART was not associated with the likelihood of sustaining the recovery of CD4 cell count.
Received 2 August 2005; accepted 27 October 2005; electronically published 23 February 2006.
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Potential conflicts of interest: none reported.
Financial support: European Commission (concerted action grant QLK2‐CT‐2000‐00002); United Kingdom Medical Research Council Sexual Health and HIV Strategy Committee (support to the European Collaborative Study Coordinating Centre). The views expressed here are those of the authors.
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Prepared by Marie‐Louise Newell (Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom), Deven Patel (Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London), Tessa Goetghebuer (Hôpital St Pierre, Brussels, Belgium), and Claire Thorne (Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London). European Collaborative Study collaborators are listed at the end of the text.