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Low Risk of CD4 Decline After Immune Recovery in Human Immunodeficiency Virus-Infected Children With Viral Suppression

Kosalaraksa P 1 , Boettiger DC 2 , Bunupuradah T 3 , Hansudewechakul R 4 , Saramony S 5 , Do VC 6 Show all authors , Sudjaritruk T 7 , Yusoff NKN 8 , Razali KAM 9 , Nguyen LV 10 , Nallusamy R 11 , Fong SM 12 , Kurniati N 13 , Truong KH 14 , Sohn AH 15 , Chokephaibulkit K 16 , TREAT Asia Pediatric HIV Observational Database

Affiliations 

  • 1 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand
  • 2 The Kirby Institute, University of New South Wales Australia, Sydney
  • 3 HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, and
  • 4 Chiangrai Prachanukroh Hospital, Thailand
  • 5 University of Health Sciences, Phnom Penh, Cambodia
  • 6 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 7 Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Thailand
  • 8 Hospital Raja Perempuan Zainab II, Kelantan, and
  • 9 Pediatric Institute, Hospital Kuala Lumpur, Malaysia
  • 10 National Hospital of Pediatrics, Hanoi, Vietnam
  • 11 Penang Hospital, and
  • 12 Hospital Likas, Kota Kinabalu, Malaysia
  • 13 Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 14 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 15 TREAT Asia/amfAR, The Foundation for AIDS Research, and
  • 16 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
J Pediatric Infect Dis Soc, 2017 Jun 01;6(2):173-177.
PMID: 27295973 DOI: 10.1093/jpids/piw031

Abstract

Background.: Regular CD4 count testing is often used to monitor antiretroviral therapy efficacy. However, this practice may be redundant in children with a suppressed human immunodeficiency virus (HIV) viral load.

Methods: Study end points were as follows: (1) a CD4 count <200 cells/mm3 followed by a CD4 count ≥200 cells/mm3 (transient CD4 <200); (2) CD4 count <200 cells/mm3 confirmed within 6 months (confirmed CD4 <200); and (3) a new or recurrent World Health Organization (WHO) stage 3 or 4 illness (clinical failure). Kaplan-Meier curves and Cox regression were used to evaluate rates and predictors of transient CD4 <200, confirmed CD4 <200, and clinical failure among virally suppressed children aged 5-15 years who were enrolled in the TREAT Asia Pediatric HIV Observational Database.

Results: Data from 967 children were included in the analysis. At the time of confirmed viral suppression, median age was 10.2 years, 50.4% of children were female, and 95.4% were perinatally infected with HIV. Median CD4 cell count was 837 cells/mm3, and 54.8% of children were classified as having WHO stage 3 or 4 disease. In total, 18 transient CD4 <200 events, 2 confirmed CD4 <200 events, and10 clinical failures occurred at rates of 0.73 (95% confidence interval [95% CI], 0.46-1.16), 0.08 (95% CI, 0.02-0.32), and 0.40 (95% CI, 0.22-0.75) events per 100 patient-years, respectively. CD4 <500 cells/mm3 at the time of viral suppression confirmation was associated with higher rates of both CD4 outcomes.

Conclusions: Regular CD4 testing may be unnecessary for virally suppressed children aged 5-15 years with CD4 ≥500 cells/mm3.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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