Long-term effects of highly active antiretroviral therapy in pretreated, vertically HIV type 1-infected children : 6 years of follow-up

Background. Several studies of children with human immunodeficiency virus (HIV) type 1 infection have demonstrated sustained increases in CD4 + cell count, even when virological failure has occurred after receipt of highly active antiretroviral therapy (HAART), but these studies were of limited duration. Moreover, the CD4 + cell count threshold at which antiretroviral treatment should be initiated is still unsettled. The aim of this study was to define the long-term impact of HAART on CD4 + cell percentage and viral load according to CD4 + cell percentages before HAART was initiated. Methods. We conducted a retrospective study of 113 pretreated HIV-1-infected children stratified by preHAART CD4 + cell percentage ( 25%). The inclusion criteria were as follows: initiating HAART with a protease inhibitor, having 6 years of follow-up after starting HAART, having a CD4 + cell count or viral load recorded before initiation of HAART, and having received mono- or dual-nucleoside therapy before starting HAART. Results. During the first 2 years of HAART, HIV-1-infected children experienced a significant increase in CD4 + cell percentage and a decrease in viral load (P 25% after 6 years of HAART. Children with CD4 + cell percentages of 5%-25% at baseline had a strong negative association with achieving CD4 + cell percentages of >30% for at least 6 and 12 months but not with achieving CD4 + cell percentages of >30% for at least 24 months. Conclusions. Long-term HAART allowed for restoration of CD4 + cell counts and control of viral loads in HIV-1-infected children. However, initiating HAART after severe immunosuppression has occurred is detrimental for the restoration of the CD4 + cell count.