Clinical Outcomes Improve with Highly Active Antiretroviral Therapy in Vertically HIV Type-1–Infected Children

• Published in: Clinical infectious diseases Vol. 43; no. 2; pp. 243 - 252
• Main Authors: Resino, Salvador, Resino, Rosa, Mª Bellón, José, Micheloud, Dariela, Gurbindo Gutiérrez, Mª Dolores, de José, Mª Isabel, Tomás Ramos, José, Martín Fontelos, Pablo, Ciria, Luis, Muñoz-Fernández, Mª Ángeles
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.07.2006; University of Chicago Press; Oxford University Press
• Subjects: AIDS; Anti-Retroviral Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - methods; Antiretrovirals; Antiviral agents; Biological and medical sciences; Child; Child health services; Child, Preschool; Children; Children & youth; Clinical medicine; Clinical outcomes; Disease control; Female; Follow-Up Studies; Highly active antiretroviral therapy; HIV; HIV / AIDS; HIV 1; HIV Infections - drug therapy; HIV Infections - transmission; Hospital admissions; Hospitalization; Human immunodeficiency virus; Human immunodeficiency virus 1; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infections; Infectious Disease Transmission, Vertical; Infectious diseases; Male; Medical sciences; Pharmacology. Drug treatments; Retrospective Studies; T lymphocytes; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Prognosis; AIDS; Maternal diseases; Immune deficiency; Infection; Chemotherapy; Treatment; Viral disease; Antiviral; Vertical transmission; Child
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/505213

Background. Use of antiretroviral therapy has resulted in a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 (HIV-1)—infected children. Methods. We performed a retrospective study involving 427 children to determine the effectiveness of different antiretroviral therapy protocols on clinical outcome. The follow-up period was divided into 5 calendar periods (CPs): CP1 (1980–1989), before antiretroviral therapy was administered; CP2 (1990–1993), when monotherapy was administered; CP3 (1994–1996), when combined therapy was administered; CP4 (1997–1998), when ⩽50% of children were receiving highly active antiretroviral therapy (HAART); and CP5 (1999–2003), when ⩾60% of children were receiving HAART. Results. Children experienced a progressive increase in the CD4+ cell count and decrease in the viral load from 1997 onwards. A lower number of AIDS cases and deaths occurred during CP5 than during the other CPs (P < .01), with a relative risk of an absence of AIDS of >20 and a relative risk of survival of >30. The AIDS rate was >50% in CP1; we observed a very strong decrease to 14% in CP2, to 16% in CP3, to 7% in CP4, and to 2% in CP5. The mortality rates in CP2 and CP3 were >6% and thereafter decreased to 0.5% in CP5. The relative risks for no hospital admission in CP4 and CP5 were >3.5. The total rates of hospital admission in CP1, CP2, and CP3 were >30%; we observed a decrease in CP4 and CP5. The duration of hospitalization decreased during the follow-up period, and it was higher in CP1 (∼30 days) than in the other periods. Conclusions. We observed that HAART produces a decrease in adverse clinical outcomes (i.e., hospital admission, AIDS, and death) in children with vertical HIV-1 infection in Madrid, Spain.