TY - JOUR
T1 - Long-term response to combination antiretroviral therapy in HIV-infected children in the Netherlands registered from 1996 to 2012
AU - Cohen, Sophie
AU - Smit, Colette
AU - van Rossum, Annemarie M. C.
AU - Fraaij, Pieter L. A.
AU - Wolfs, Tom F. W.
AU - Geelen, Sibyl P. M.
AU - Schölvinck, Elisabeth H.
AU - Warris, Adilia
AU - Scherpbier, Henriette J.
AU - Pajkrt, Dasja
AU - Dutch Paediatric HIV Study Group
PY - 2013/10/23
Y1 - 2013/10/23
N2 - OBJECTIVES: To describe demographic and treatment characteristics of the Dutch vertically HIV-infected paediatric population from 1996 to 2012, and to investigate the long-term virological and immunological response to combination antiretroviral therapy (cART), with emphasis on the influence of age at cART initiation and initial CD4 cell counts.DESIGN: Descriptive cohort study.METHODS: From 1996 to 2012, all paediatric HIV clinics in the Netherlands provided data on their HIV-infected population. Descriptive statistics, parametric and non-parametric comparative tests, and random-effects linear regression models were performed to investigate the different aspects of this cohort.RESULTS: A total of 229 vertically HIV-infected children were included. The majority of all mothers (64%) and almost half of the children (43%) originated from sub-Saharan Africa. Ritonavir-boosted lopinavir and efavirenz have replaced indinavir, nelfinavir and nevirapine as preferred first-line cART regimens. Long-term CD4 T-cell reconstitution (with CD4 cell counts corrected for age) was independent of age and CD4 cell count at cART initiation. The decline in HIV viral load after cART introduction occurred faster over the studied time period. The percentage of children with an undetectable viral load rose substantially from 1996 to 2012. Mortality was 0.3 per 100 person-years.CONCLUSION: A sustained immunological response in the Dutch paediatric HIV-infected population was independent of age as well as CD4 cell count at cART initiation, despite a higher initial HIV viral load in the youngest children. The percentage of children with an undetectable HIV viral load rose substantially over the years and there was a low mortality rate in comparison with reports from other industrialized countries.
AB - OBJECTIVES: To describe demographic and treatment characteristics of the Dutch vertically HIV-infected paediatric population from 1996 to 2012, and to investigate the long-term virological and immunological response to combination antiretroviral therapy (cART), with emphasis on the influence of age at cART initiation and initial CD4 cell counts.DESIGN: Descriptive cohort study.METHODS: From 1996 to 2012, all paediatric HIV clinics in the Netherlands provided data on their HIV-infected population. Descriptive statistics, parametric and non-parametric comparative tests, and random-effects linear regression models were performed to investigate the different aspects of this cohort.RESULTS: A total of 229 vertically HIV-infected children were included. The majority of all mothers (64%) and almost half of the children (43%) originated from sub-Saharan Africa. Ritonavir-boosted lopinavir and efavirenz have replaced indinavir, nelfinavir and nevirapine as preferred first-line cART regimens. Long-term CD4 T-cell reconstitution (with CD4 cell counts corrected for age) was independent of age and CD4 cell count at cART initiation. The decline in HIV viral load after cART introduction occurred faster over the studied time period. The percentage of children with an undetectable viral load rose substantially from 1996 to 2012. Mortality was 0.3 per 100 person-years.CONCLUSION: A sustained immunological response in the Dutch paediatric HIV-infected population was independent of age as well as CD4 cell count at cART initiation, despite a higher initial HIV viral load in the youngest children. The percentage of children with an undetectable HIV viral load rose substantially over the years and there was a low mortality rate in comparison with reports from other industrialized countries.
KW - antiretroviral therapy
KW - children
KW - HIV
KW - immunological reconstitution
KW - mortality
KW - the Netherlands
KW - vertical transmission
KW - virological response
KW - Journal Article
U2 - 10.1097/01.aids.0000432451.75980.1b
DO - 10.1097/01.aids.0000432451.75980.1b
M3 - Article
C2 - 23842124
SN - 0269-9370
VL - 27
SP - 2567
EP - 2575
JO - AIDS
JF - AIDS
IS - 16
ER -