Immunologic and virologic responses to HAART in severely immunocompromised HIV-1-infected children

摘要: Objective: To determine the long-term immunologic and virologic effects of highly active antiretroviral therapy (HAART) in children with AIDS. Design: A prospective observational study. Setting: Two pediatric HIV clinics. Participants: Twenty-five protease-inhibitor naive HIV-infected (aged 2-18 years) advanced disease (CD4 ≤ 6%). Intervention: HAART (one protease inhibitor one or more nucleoside analogs). Diphtheria tetanus immunization six patients after 18 months therapy. Main outcome measures: Changes percentage CD4 cells plasma HIV-1 RNA levels; post-treatment assays lymphoproliferative responses to recall antigens; cell memory phenotype. Results: Median duration follow-up was 18.8 (range, 7.5-28 months). At baseline 2% 0-6%), this increased significantly 16% 3-48%) above at 12 (P = 0.002). The mean maximum increase 20.7% (range 4-48%) which corresponds 657 × 10 6 cells/l 30-2240 cells/l) baseline. By contrast, median viral load not lower than 0.34), only 25% had sustained undetectable load. Of reconstituted 70% were naive, none subjects diphtheria although 40% did develop Candida, an environmental antigen. single toxoid produced three out patients. Conclusions: associated increases counts, despite a high incidence 'virologic failure'. counts proportion higher have been reported adults, may be reflection greater thymic activity children. Memory clones for antigens encountered past are prevalent before could expanded without additional antigenic exposure.