Clinical Outcomes After an Unstructured Treatment Interruption in Children and Adolescents With Perinatally Acquired HIV Infection
- 1 March 2008
- journal article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 121 (3), e513-e521
- https://doi.org/10.1542/peds.2007-1086
Abstract
OBJECTIVE. An unstructured treatment interruption in children with perinatally acquired HIV infection is an issue with unresolved significance. The objective of this study was to investigate the actual prevalence and clinical outcomes of a treatment interruption in children and adolescents with perinatally acquired HIV-1 infection. METHODS. Clinical data were analyzed for 72 children and adolescents who had HIV-1 infection and stopped their medications at 4 academic centers in the United States between January 2000 and September 2004. RESULTS. Among 405 patients with perinatal HIV-1 infection, 72 (17.8%) experienced a treatment interruption during the observation period. The mean age of patients at the time of the treatment interruption was 12.8 years, and the mean length of the treatment interruption was 14 months. Medication fatigue was the most common reason for a treatment interruption. The CD4+ T-cell percentage nadir before the treatment interruption did not predict CD4+ T-cell percentage declines during the treatment interruption; however, the CD4+ T-cell percentage gain from nadir to the time of the treatment interruption predicted CD4+ T-cell percentage declines during the treatment interruption. During the median follow-up of 19 months (range: 6–48 months), 48 (67%) patients resumed antiretroviral medications. As expected, there was a continuous CD4+ T-cell percentage decrease and plasma HIV-1 RNA increase during the observation period. Overall, 7 (10%) patients were admitted to the hospital; 2 (3%) patients experienced an AIDS-defining illness. CONCLUSIONS. An unstructured treatment interruption seems to be a major issue for youth with perinatally acquired HIV-1 infection. Patients who experienced the greatest rise in CD4+ T-cell percentage on treatment had the largest CD4+ T-cell percentage decline after the treatment interruption. Close monitoring is required when a treatment interruption occurs in children and adolescents with HIV infection.Keywords
This publication has 27 references indexed in Scilit:
- Efficient hybrid EM for linear and nonlinear mixed effects models with censored responseComputational Statistics & Data Analysis, 2007
- Sustained HIV Viral Suppression following Treatment Interruption: An Observational StudyAIDS Research and Human Retroviruses, 2006
- Treatment Interruption of Highly Active Antiretroviral Therapy in Patients with Nadir CD4 Cell Counts >200 Cells/mm3The Journal of Infectious Diseases, 2005
- Discontinuation of Antiretroviral Therapy in Patients with Chronic HIV Infection: Clinical, Virologic, and Immunologic ConsequencesAIDS Patient Care and STDs, 2005
- Can highly active antiretroviral therapy be interrupted in patients with sustained moderate HIV RNA and > 400 CD4+ cells/µl? Impact on immunovirological parametersJournal of Medical Virology, 2005
- Adherence to MedicationNew England Journal of Medicine, 2005
- A Prospective, Randomized Trial of Structured Treatment Interruption for Patients with Chronic HIV Type 1 InfectionClinical Infectious Diseases, 2005
- Extended antiretroviral treatment interruption in HIV‐infected patients with long‐term suppression of plasma HIV RNAHIV Medicine, 2005
- Influence of Prior Structured Treatment Interruptions on the Length of Time without Antiretroviral Treatment in Chronically HIV-Infected SubjectsAIDS Research and Human Retroviruses, 2004
- Effect of prolonged discontinuation of successful antiretroviral therapy on CD4 T cellsAIDS, 2004