Predictors of faster virological suppression in early treated infants with perinatal HIV from Europe and Thailand The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) and Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies (EPIICAL) study groups
2019
Objective: To identify predictors of faster time to virological suppression among infants
starting combination antiretroviral therapy (cART) early in infancy.
Design: Cohort study of infants from Europe and Thailand included in studies participating in the European Pregnancy and Paediatric HIV Cohort Collaboration.
Methods: Infants with perinatal HIV starting cART aged less than 6 months with at least
1 viral load measurement within 15 months of cART initiation were included. Multivariable interval-censored flexible parametric proportional hazards models were used
to assess predictors of faster virological suppression, with timing of suppression
assumed to lie in the interval between last viral load at least 400 and first viral load
less than 400 copies/ml.
Results: Of 420 infants, 59% were female and 56% from Central/Western Europe, 26%
United Kingdom/Ireland, 15% Eastern Europe and 3% Thailand; 46 and 54% started a
boosted protease inhibitor-based or nonnucleoside reverse transcriptase inhibitorbased regimen, respectively. At cART initiation, the median age, CD4þ% and viral
load were 2.9 [interquartile range (IQR): 1.4–4.1] months, 34 (IQR: 24–45)% and 5.5
(IQR: 4.5–6.0) log10 copies/ml, respectively. Overall, an estimated 89% (95% confidence interval: 86–92%) achieved virological suppression within 12 months of cART
start. In multivariable analysis, younger age [adjusted hazard ratio (aHR): 0.84 per
month older; P < 0.001], higher CD4þ% (aHR: 1.11 per 10% higher; P ¼ 0.010) and
lower log10 viral load (aHR: 0.85 per log10 higher; P < 0.001) at cART initiation
independently predicted faster virological suppression.
Conclusion: We observed a significant independent effect of age at cART initiation,
even within a narrow 6 months window from birth. These findings support the
earliest feasible cART initiation in infants and suggest that early therapy influences
key virological and immunological parameters that could have important consequences for long-term health.
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