Early antiretrovirals boost immune response in HIV infants
Infants with perinatal HIV infection should start antiretroviral (ART) therapy before three months of age, European researchers say.
Babies in their study who received combination ART (cART) - i.e., at least three drugs - in the first three months of life had higher CD4 counts and lower viral loads through age one compared to babies whose treatment was deferred, the researchers report.
"It is true that the long term outcome is similar in both groups. But in early life, there are no predictors for rapid evolution or long term non-progression. This is why it is better to initiate treatment in all children," said lead author Dr. Tessa Goetghebuer from the CHU St. Pierre, Brussels, Belgium, in an email to Reuters Health.
"Because early initiation of treatment in HIV vertically infected infants is now recommended in all guidelines, efforts should be made to establish the diagnosis of infection as soon as possible after birth," she and her colleagues wrote in a 23rd December online article in Clinical Infectious Diseases.
Their study used data from the European Infant Collaborative Group on 139 infants with perinatally acquired HIV infection (but not full-blown acquired immunodeficiency syndrome) who started cART therapy before age one, including 96 who were started on cART before three months of age.
The baseline CD4 percentages and viral loads were similar between the groups. Viral loads and CD4 levels were measured prior to treatment and at 6, 12, 18, 24, and 48 months of age.
Compared to the deferred treatment group, the early treatment group had a slower decline in CD4 percentages, lower peak viral load, and a shorter time until viral suppression (i.e., to less than 500 log copies/mL) during the first year of life, the authors report.
At six months of age, in the early and deferred groups, respectively, CD4 percentages were 43% vs 34%, viral loads were 2.3 vs 4.6 copies/mL, and percentages achieving virological suppression were 63% and 19% (p < 0.001 for each).
At one year of age, there was a trend toward a lower viral load in the early ART group, but none of the virological and immunological differences between the two groups was statistically significant.
The researchers felt their sample size might have been too small to show an effect beyond a year.
"However," they hope, "it is possible that the functional competences of CD4 cells are influenced by early initiation of therapy and may maintain an impact on the clinical outcome after the age of 12 months."
"The sooner the treatment is started, the better the virological control," the authors conclude. "This observation is important, because viral load peak may be correlated with the establishment of a reservoir of latently infected cells."
By C. Vidya Shankar MD
SOURCE: http://bit.ly/xrLY4Q
Clin Infect Dis 2011.
Medscape Today
http://www.medscape.com/viewarticle/757390
More...
