Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy

Elena Chiappini, Luisa Galli, Pier Angelo Tovo, Clara Gabiano, Catiuscia Lisi, Stefania Bernardi, Alessandra Viganò, Alfredo Guarino, Carlo Giaquinto, Susanna Esposito, Raffaele Badolato, Cesare Di Bari, Raffaella Rosso, Orazio Genovese, Massimo Masi, Antonio Mazza, Maurizio De Martino

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article number1471
Pages (from-to)140
Number of pages1
JournalBMC Infectious Diseases
Volume9
DOIs
Publication statusPublished - Aug 26 2009

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Highly Active Antiretroviral Therapy
Secondary Prevention
HIV Infections
HIV-1
Viral Load
HIV
Parturition
T-Lymphocytes

ASJC Scopus subject areas

  • Infectious Diseases

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Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy. / Chiappini, Elena; Galli, Luisa; Tovo, Pier Angelo; Gabiano, Clara; Lisi, Catiuscia; Bernardi, Stefania; Viganò, Alessandra; Guarino, Alfredo; Giaquinto, Carlo; Esposito, Susanna; Badolato, Raffaele; Di Bari, Cesare; Rosso, Raffaella; Genovese, Orazio; Masi, Massimo; Mazza, Antonio; De Martino, Maurizio.

In: BMC Infectious Diseases, Vol. 9, 1471, 26.08.2009, p. 140.

Research output: Contribution to journalArticle

Chiappini, E, Galli, L, Tovo, PA, Gabiano, C, Lisi, C, Bernardi, S, Viganò, A, Guarino, A, Giaquinto, C, Esposito, S, Badolato, R, Di Bari, C, Rosso, R, Genovese, O, Masi, M, Mazza, A & De Martino, M 2009, 'Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy', BMC Infectious Diseases, vol. 9, 1471, pp. 140. https://doi.org/10.1186/1471-2334-9-140
Chiappini, Elena ; Galli, Luisa ; Tovo, Pier Angelo ; Gabiano, Clara ; Lisi, Catiuscia ; Bernardi, Stefania ; Viganò, Alessandra ; Guarino, Alfredo ; Giaquinto, Carlo ; Esposito, Susanna ; Badolato, Raffaele ; Di Bari, Cesare ; Rosso, Raffaella ; Genovese, Orazio ; Masi, Massimo ; Mazza, Antonio ; De Martino, Maurizio. / Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy. In: BMC Infectious Diseases. 2009 ; Vol. 9. pp. 140.
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abstract = "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.",
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AU - Chiappini, Elena

AU - Galli, Luisa

AU - Tovo, Pier Angelo

AU - Gabiano, Clara

AU - Lisi, Catiuscia

AU - Bernardi, Stefania

AU - Viganò, Alessandra

AU - Guarino, Alfredo

AU - Giaquinto, Carlo

AU - Esposito, Susanna

AU - Badolato, Raffaele

AU - Di Bari, Cesare

AU - Rosso, Raffaella

AU - Genovese, Orazio

AU - Masi, Massimo

AU - Mazza, Antonio

AU - De Martino, Maurizio

PY - 2009/8/26

Y1 - 2009/8/26

N2 - 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.

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