Background: Early highly active antiretroviral therapy ( HAART), started within the first months of age, has been proven to be the optimal strategy to prevent immunological and clinical deterioration in perinatally HIV-infected children. Nevertheless, data about long-term follow-up of early treated children are lacking. Methods: We report data from 40 perinatally HIV-infected-children receiving early HAART, with a median follow-up period of 5.96 years (interquartile range [IQR]: 4.21-7.62). Children were enrolled at birth in the Italian Register for HIV Infection in Children. Comparison with 91 infected children born in the same period, followed-up from birth, and receiving deferred treatment was also provided. Results: Nineteen children (47.5%) were still receiving their first HAART regimen at last follow-up. In the remaining children the first regimen was discontinued, after a median period of 3.77 years (IQR: 1.71-5.71) because of viral failure (8 cases), liver toxicity (1 case), structured therapy interruption (3 cases), or simplification/switch to a PI-sparing regimen (9 cases). Thirty-nine (97.5%) children showed CD4(+) T-lymphocyte values>25%, and undetectable viral load was reached in 31 (77.5%) children at last visit. Early treated children displayed significantly lower viral load than not-early treated children, until 6 years of age, and higher median CD4(+) T-lymphocyte percentages until 4 years of age. Twenty-seven (29.7%) not-early treated vs. 0/40 early treated children were in clinical category C at last follow-up (P < 0.0001). Conclusion: Our findings suggest that clinical, virologic and immunological advantages from early-HAART are long-lasting. Recommendations indicating the long-term management of early treated children are needed.
|Autori:||Author(s): Chiappini; E; Galli; L; Tovo; PA; Gabiano; C; Lisi; C; Bernardi; S; Vigano; A; Guarino; A; Giaquinto; C; Esposito; S; Badolato; R; Di Bari; C; Rosso; R; Genovese; O; Masi; M; Mazza; A; de Martino; M Italian Register for HIV Infection Other Partecipants: Osimani; P; Cordiali; R; De Mattia; D; Manzinonna; M; Di Bari; C; Ruggeri; M; Masi; M; Miniaci; A; Specchia; F; Ciccia; M; Lanari; M; Baldi; F; Battisti; L; Bertulli; C; Dessì; C; Pintor; C; Dedoni; M; Fenu; ML; Cavallini; R; Anastasio; E; Magnolia; MG; sticca; M; Pomero; G; Bezzi; T; Fiumana; E; Bonsignori; F; De Gaudio; M; Gervaso; P; Cecchi; MT; Viscoli; C; Cosso; D; Timitilli; A; Stronati; M; Plebani; A; Semino; M; Tei; F; Giacomet; V; Pivetti; V; Salvini; F; Zuccotti; GV; Giovannini; M; Ferraris; G; Liprieri; R; Moretti; C; Cellini; M; Cano; MC; Paolucci; P; Bruzzese; E; Giannattasio; A; Tarallo; L; Tancredi; F; Pennazzato; M; Rampon; O; Dalle Nogare; ER; Sanfilippo; A; Romano A; Saitta; M; Dodi; I; Bandello; M; Maccabruni; A; Felici; L; Consolini R; et al|
|Titolo:||Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy|
|Anno del prodotto:||2009|
|Digital Object Identifier (DOI):||10.1186/1471-2334-9-140|
|Appare nelle tipologie:||1.1 Articolo in rivista|