Written by NIH
T cells © Russell Kightley
Children with perinatal HIV infection who begin antiretroviral therapy (ART) experience a typically good recovery of CD4 T cells, but the probability of reaching 500 cells / mm3 or more is higher for those with lower immune suppression prior to initiation of treatment, according to a study published in March 27 edition of AIDS.
Paulo Krogstad from the David Geffen School of Medicine at UCLA and colleagues evaluated the persistence of low CD4 counts despite viral suppression on ART in more than 900 children in the US, the Caribbean and Latin America who started treatment with age of 5 years or more.
The researchers found that after 1 year of viral suppression under ART, 99% of children achieved a CD4 cell count of at least 200 cells / mm3 - the threshold for many opportunistic diseases. However, 14% of children still had a CD4 count below 500 cells / mm3 after 1 year of viral suppression and 8% remained below this level even after 2 years.
The time it took to reach 500 cells / mm3 or greater with pre-treatment of the CD4 count decreased from about half a year for children who started therapy with 350-499 cells / mm3 to 1,3 years for those who started with less than 200 cells / mm3. Only 9 children (1%) exhibited AIDS-defining events, including four of them during the first 6 months with complete virologic suppression (Viral load below 40 copies of RNA per milliliter of blood).
"ART improves the CD4 + cell count in most children, but the time taken for the CD4 + cell count to reach at least 500 cells was highly dependent on the immune status line," the researchers concluded. "Some children do not reach a number of CD4 + T lymphocytes from 500 cells / [cells / mm3] despite having been maintained for 2 years with complete virological suppression. AIDS defining events occurred in 1% of the population, including children in whom virologic suppression and the best CDXNX + T cell count were achieved. "
The text Below is an excerpt from a press statement. Describing the investigation in more detail.
For most children with HIV and low immune cell counts, they showed growth after treatment
NIH-funded study finds T-cell level returns to normal over time
March 23 2015 - Most children with HIV who have low levels of a count of immune cells eventually recover, demonstrating good levels of CD4 T cells after starting treatment, according to a study by researchers funded by the National Institutes of Health.
CDXNXX + T cell failure, one of the main targets of HIV, rebounding after the virus has been suppressed with medication occurs in about fifteen percent of adult patients and is associated with serious, fatal diseases. Researchers conducted the current study to find out to what extent children who were infected with HIV at any time of birth may be at risk for this condition and if these failures carried out with a high risk for serious infection.
"The good news is that this condition occurs rarely in children or young people with HIV," said study author Rohan Hazra, head of the pregnant and pediatric infectious disease at the NIH branch of Eunice Kennedy Shriver National Institute of Child Health and Human Development since funding for the study. "Comparatively few children whose CD4 + cells did not return to did not appear to be at greater risk for severe infection than children with higher CD4 + counts."
He added that the findings do not appear to change treatment recommendations for children with HIV, which include antiretroviral drugs to suppress the virus and periodic monitoring of the exams to detect early signs of any serious infection.
The results of the study were published online in AIDS, a study by a team of researchers at several institutions in Brazil and the United States.The first author of the study was Paul Krogstad of the David Geffen School of Medicine of the University of California at Los Angeles.
To conduct their analysis, the researchers reviewed data from three research networks caring for more than 3.700 children in the US, Central and South America and the Caribbean who were infected with HIV before or during birth.
Researchers tracked the CD4 + count of 933 children for at least 5 years from when they began to rreceber anti-HIV treatment. Healthy CD4 + counts from other cells vary between 500-1 800-1200 cells per blood sample. Less than 500 cells per sample is considered low and 200 or less per sample is considered too low. After one year of anti-HIV treatment, 86 percent of children in the study scored CD4 + counts of 500 or more. After two years of anti-HIV treatment, 92% exceeded this threshold.
The researchers also reviewed the medical history of these children through their records for signs of severe illness during the course of their treatment. Known as the CDC Category C Events, these diseases are a sign of 0's severely impaired immune system seen in people with AIDS. A total of nine children experienced these events. The occurrence of these events did not differ statistically between CD4 + cell counts below 500 at the time of the event (four children) and those with counts above 500 (five children).
The study authors noted that for adults with low CD4 + counts at the start of treatment, CD4 + counts in children increase to 500 or more with the passage of time after treatment has been started. But despite such increases, some children had category C conditions or other major diseases during the first three years of HIV treatment. Researchers were called for additional studies in order to understand this increased risk of disease.
About Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's website at http://www.nichd.nih.gov.
About the National Institute of Health (NIH): NIH, the agency's medical research nations, includes 27 Institutes and Centers and is a component of the Department of Health and Human Services. NIH is the leading federal agency to conduct and support both basic and clinically as well as translational research on medical research and is investigating the causes, treatments and cures for common diseases and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
Translated by Claudio Souza's original Most children with HIV have a recovery of their immune system treatment
Reviewed by Mara Macedo
P Krogstad, K Patel, Karalius B, et al (on behalf of the HIVAIDS Pediatric Cohort Study, IMPAACT 219C, and NICHD International Website the researchers development initiative). Incomplete immune reconstitution despite virological suppression in HIV-1-infected children and adolescents. AIDS 29 (6): 683-693. March 27 of 2015.
National Institutes of Health. For most children with HIV and low immune cell count, cells rebound after treatment. Press release. March 23 of 2015.
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