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Age influences response to HAART in children
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NEW YORK (Reuters Health) - Age plays a role in children's immunologic and virologic response to highly active antiretroviral therapy (HAART) for HIV infection, UK researchers report in the September 24th issue of AIDS.
"The difference in immunological and virologic responses to HAART in HIV-infected children of different ages has implications for decisions about the timing of therapy initiation as differences in the risks and benefits of HAART initiation vary according to age," senior author Dr. Diana M. Gibb told Reuters Health.
Dr. Gibb and colleagues at the Medical Research Council Clinic Trials Unit, London, evaluated 324 previously untreated children starting HAART. Of these, 265 had available data on pre-HAART CD4 and RNA.
At 6 months, CD4 percentage increases of more than 10% were significantly more likely in younger children and those with lower pre-HAART values. These changes were unrelated to pre-HAART RNA.
Conversely, HIV-1 RNA suppression to below 400 copies per mL at 6 months was more likely in older children and was unrelated to pre-HAART HIV-1 RNA or CD4 percentage.
Overall, longer term increases in CD4 percentages occurred faster and decreases in HIV-1 RNA took place more slowly in younger children. The poorer virological response in younger children, the investigators note, increases the risk of resistance.
In children under the age of 2 years with a baseline CD4 percentage of 25% or less, the median time to reach 30% or more was 12 months. This time increased progressively in older children as CD4 percentage decreased.
The researchers conclude that these differences should be taken into consideration when initiating HAART in children.
AIDS 2004;18:1915-1924.
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