Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study
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Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study. / Smith, Colette; Marques, Laura; Klein, Nigel; Gullen, Sara; Judd, Ali; Thorne, Claire; Goodall, Ruth; Koenigs, Christoph; Spoulou, Vana; Prata, Filipa; Goetghebuer, Tessa; Chiappini, Elena; Galli, Luisa; Naver, Lars; Giaquinto, Carlo; Gibb, Diana M.; Marczynska, Magdalena; Okhonskaia, Liubov; Klimkait, Thomas; Lallernant, Marc; Ngo-Giang-Huong, Nicole; Kiseleva, Galyna; Malyuta, Ruslan; Volokha, Alla; European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord .
In: CLIN INFECT DIS, Vol. 70, No. 3, 16.01.2020, p. 404-415.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study
AU - Smith, Colette
AU - Marques, Laura
AU - Klein, Nigel
AU - Gullen, Sara
AU - Judd, Ali
AU - Thorne, Claire
AU - Goodall, Ruth
AU - Koenigs, Christoph
AU - Spoulou, Vana
AU - Prata, Filipa
AU - Goetghebuer, Tessa
AU - Chiappini, Elena
AU - Galli, Luisa
AU - Naver, Lars
AU - Giaquinto, Carlo
AU - Gibb, Diana M.
AU - Marczynska, Magdalena
AU - Okhonskaia, Liubov
AU - Klimkait, Thomas
AU - Lallernant, Marc
AU - Ngo-Giang-Huong, Nicole
AU - Kiseleva, Galyna
AU - Malyuta, Ruslan
AU - Volokha, Alla
AU - European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord
AU - Kobbe, Robin
N1 - © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2020/1/16
Y1 - 2020/1/16
N2 - BACKGROUND: In human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART.METHODS: Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status.RESULTS: Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001).CONCLUSIONS: One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.
AB - BACKGROUND: In human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART.METHODS: Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status.RESULTS: Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001).CONCLUSIONS: One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.
KW - Adolescent
KW - Adult
KW - Aged
KW - Anti-HIV Agents/therapeutic use
KW - Antiretroviral Therapy, Highly Active
KW - CD4 Lymphocyte Count
KW - Child
KW - Cohort Studies
KW - Europe/epidemiology
KW - Female
KW - HIV
KW - HIV Infections/drug therapy
KW - Humans
KW - Immunity
KW - Pregnancy
KW - Prevalence
KW - Thailand/epidemiology
KW - Viral Load
U2 - 10.1093/cid/ciz253
DO - 10.1093/cid/ciz253
M3 - SCORING: Journal article
C2 - 30919882
VL - 70
SP - 404
EP - 415
JO - CLIN INFECT DIS
JF - CLIN INFECT DIS
SN - 1058-4838
IS - 3
ER -
