Older children with HIV may need to start treatment sooner to normalize future CD4 count

October 29, 2013

Although younger children with HIV are at high risk of disease progression if not treated, new research published this week in PLOS Medicine indicates that they have good potential for achieving high CD4 counts (a measure of a type of white blood cell that correlates with immune function) in later life provided antiretroviral therapy (ART) is initiated according to current treatment guidelines. However, the research also suggests that the recommended CD4 count thresholds for ART initiation are unlikely to maximize immunological health in children who have never received ART before the age of ten years.

For aged 2-3 years, ART initiation is currently recommended once their CD4 count drops below 750 cells/microliter of blood, whereas for older children the threshold for ART initiation is 350 CD4 cells/microliter. Because of improved ART coverage, many more HIV-infected children now survive into adulthood than in the past. It is therefore important to know how the timing of ART initiation in childhood affects long-term immune reconstitution.

The research led by Joanna Lewis from University College London, UK, was an international collaboration and used data collected during the ARROW trial, a study designed to investigate monitoring strategies during first-line HIV treatment in 1,206 HIV-positive children in Uganda and Zimbabwe. In this study the researchers used children's CD4 counts that were collected every 12 weeks for approximately 4 years to analyze how the long-term CD4 count outcomes changed after ART initiation.

In three-quarters of the children, CD4 counts increased rapidly immediately after ART initiation, then slowed before eventually reaching a constant level of about 80% of the CD4 count expected in an HIV-uninfected child of the same age. Using this data the researchers were able to predict CD4 trajectories for children starting ART at different ages and with different CD4 counts. Higher long-term counts were predicted for children starting ART earlier and with higher CD4 counts. However, using current recommended CD4 thresholds for starting ART in children older than 5 years, lower CD4 counts were predicted when they become adults, such that children who have been infected from childbirth and who remain untreated beyond 10 years of age are unlikely ever to normalize CD4 count, regardless of CD4 count at ART initiation.

The authors conclude, "[o]ur results indicate that although younger ART-naive children are at high risk of , provided they start ART following current WHO/Paediatric European Network for Treatment of AIDS/US Centers for Disease Control and Prevention guidelines, they have good potential for achieving high CD4 levels in later life. However, to attain maximum immune reconstitution in older children, particularly those >10 y, ART may need to be initiated regardless of CD4 cell count."

Explore further: HIV elimination in South Africa could be achieved by current treatment policy

More information: Picat M-Q, Lewis J, Musiime V, Prendergast A, Nathoo K, et al. (2013) Predicting Patterns of Long-Term CD4 Reconstitution in HIV-Infected Children Starting Antiretroviral Therapy in Sub-Saharan Africa: A Cohort-Based Modelling Study. PLoS Med 10(10): e1001542. DOI: 10.1371/journal.pmed.1001542

Related Stories

HIV elimination in South Africa could be achieved by current treatment policy

October 22, 2013
The current antiretroviral treatment policy in South Africa could lead to elimination of HIV within the country over the next 24 to 34 years, but a universal test and treat (UTT) approach could achieve elimination 10 years ...

CD4 count is non-inferior to viral load for treatment switching in adults with HIV

August 6, 2013
For adults infected with HIV in Thailand a monitoring strategy based on CD4 count (a type of white blood cell) is non-inferior to the recommended monitoring strategy measuring the amount of HIV virus in a patient's blood, ...

Study shows no increased risk for heart attacks among HIV-positive patients with high CD4 cell count

October 24, 2013
Patients who are HIV-positive and have high CD4 cell counts—or have a high number of white blood cells that fight infections—aren't at an increased risk for heart attacks compared to patients who are HIV-negative, according ...

No increase in risk of death for patients with well-controlled HIV, reports AIDS journal

March 11, 2013
For HIV-infected patients whose disease is well-controlled by modern treatment, the risk of death is not significantly higher than in the general population, according to a study published in AIDS, official journal of the ...

Study: Antiretroviral therapy for HIV-1 in first four months is crucial

January 16, 2013
Patients who are started on antiretroviral therapy for HIV-1 infection within four months of estimated infection date—and who have higher counts of CD4+ T-cells at the initiation of therapy—demonstrate a stronger recovery ...

Early therapy for HIV vital

February 1, 2013
New insight into the optimal timing of therapy for HIV infection could give patients a better chance of responding to potential cure strategies of the future.

Recommended for you

Girl's HIV infection seems under control without AIDS drugs

July 24, 2017
A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines—more evidence that early treatment can occasionally cause a long remission that, ...

Meds by monthly injection might revolutionize HIV care (Update)

July 24, 2017
Getting a shot of medication to control HIV every month or two instead of having to take pills every day could transform the way the virus is kept at bay.

Candidate AIDS vaccine passes early test

July 24, 2017
The three-decade-old quest for an AIDS vaccine received a shot of hope Monday when developers announced that a prototype triggered the immune system in an early phase of human trials.

Paris spotlight on latest in AIDS science

July 21, 2017
Some 6,000 HIV experts gather in Paris from Sunday to report advances in AIDS science as fading hopes of finding a cure push research into new fields.

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...

Heart toxin reveals new insights into HIV-1 integration in T cell genome

July 20, 2017
Human immunodeficiency virus (HIV)-1 may have evolved to integrate its genetic material into certain immune-cell-activating genes in humans, according to new research published in PLOS Pathogens.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.