Objective: To investigate the impact of early versus deferred combined antiretroviral treatment (ART) in asymptomatic or moderately symptomatic [Centers for Disease Control and Prevention (CDC) category N, A or B] infants with perinatal HIV-1 infection. Methods: A multi-centre nationwide case–control study was conducted. Data from 30 infants treated with combined ART with three or more drugs before 6 months of age were compared with data from 103 infants starting ART with three or more drugs after 6 months of age. The median follow-up time was 4.1 years (range, 1.0–6.5 years). Results: No difference was evident in the first available viral load and CD4 T-lymphocyte percentage between the two groups of children. Early-treated infants showed significantly lower viral loads than infants receiving deferred treatment at all the follow-up periods. A higher proportion of early-treated infants than infants receiving deferred treatment (73.3% versus 30.1%; P < 0.0001) reached an undetectable viral load. Higher CD4 T-lymphocyte percentages were found in early-treated infants at 13– 24 (P < 0.0001), 25–36 (P < 0.0001), and 37–48 (P ¼ 0.003) months of age. No earlytreated infant versus 20 of 103 (19.4%) infants receiving deferred ART (P ¼ 0.02) showed a CD4 T-lymphocyte percentage of less than 15% at one time point during follow-up. No CDC category A, B or C clinical event occurred in early-treated infants over the follow-up period while 44 of 103 (42.7%) infants receiving deferred treatment presented a decline in the CDC category. Kaplan–Meier analyses revealed significant differences in CDC category A (P ¼ 0.0002), B (P ¼ 0.0003), and C (P ¼ 0.0018) eventfree survivals. Conclusion: The data suggest virologic, immunologic, and clinical benefits from early administration of ART.

Virologic, immunologic, and clinical benefits from early combined antiretroviral therapy in infants with perinatal HIV-1 infection

BEZZI, Teresa Maria;FIUMANA, Elisa;
2006

Abstract

Objective: To investigate the impact of early versus deferred combined antiretroviral treatment (ART) in asymptomatic or moderately symptomatic [Centers for Disease Control and Prevention (CDC) category N, A or B] infants with perinatal HIV-1 infection. Methods: A multi-centre nationwide case–control study was conducted. Data from 30 infants treated with combined ART with three or more drugs before 6 months of age were compared with data from 103 infants starting ART with three or more drugs after 6 months of age. The median follow-up time was 4.1 years (range, 1.0–6.5 years). Results: No difference was evident in the first available viral load and CD4 T-lymphocyte percentage between the two groups of children. Early-treated infants showed significantly lower viral loads than infants receiving deferred treatment at all the follow-up periods. A higher proportion of early-treated infants than infants receiving deferred treatment (73.3% versus 30.1%; P < 0.0001) reached an undetectable viral load. Higher CD4 T-lymphocyte percentages were found in early-treated infants at 13– 24 (P < 0.0001), 25–36 (P < 0.0001), and 37–48 (P ¼ 0.003) months of age. No earlytreated infant versus 20 of 103 (19.4%) infants receiving deferred ART (P ¼ 0.02) showed a CD4 T-lymphocyte percentage of less than 15% at one time point during follow-up. No CDC category A, B or C clinical event occurred in early-treated infants over the follow-up period while 44 of 103 (42.7%) infants receiving deferred treatment presented a decline in the CDC category. Kaplan–Meier analyses revealed significant differences in CDC category A (P ¼ 0.0002), B (P ¼ 0.0003), and C (P ¼ 0.0018) eventfree survivals. Conclusion: The data suggest virologic, immunologic, and clinical benefits from early administration of ART.
2006
E., Chiappini; L., Galli; Atovo, P. i. e. r.; C., Gabiano; G., Castelli Gattinara; A., Guarino; R., Baddato; C., Giaquinto; C., Lisi; M., de Martino; P., Osimani; R., Cordiali; D., De Mattia; M., Manzionna; C., Di Bari; M., Ruggeri; M., Masi; A., Miniaci; F., Specchia; M., Ciccia; M., Lanari; F., Baldi; L., Battisti; C., Fiorino; C., Dessı`; C., Pintor; M., Dedoni; M. L., Fenu; R., Cavallini; E., Anastasio; F., Merolla; M., Sticca; G., Pomero; Bezzi, Teresa Maria; Fiumana, Elisa; F., Bonsignori; P., Gervaso; E., Seini; M. T., Cecchi; D., Cosso; A., Timitilli; M., Stronati; A., Plebani; R., Pinzani; I., Bongianin; A., Vigano`; V., Giacomet; P., Erba; F., Salvini; G. V., Zuccotti; M., Giovannini; G., Ferraris; R., Lipreri; C., Moretti; M., Cellini; M. C., Cano; P., Paolucci; E., Bruzzese; G., De Marco; L., Tarallo; F., Tancredi; M., Pennazzato; O., Rampon; E. R., Dalle Nogare; A., Sanfilippo; A., Romano; M., Saitta; I., Dodi; A., Barone; A., Maccabruni; R., Consolini; A., Legitimo; C., Magnani; P., Falconieri; C., Fundaro`; O., Genovese; A., Panzanella; A. M., Casadei; A., Martino; C., Concato; G., Anzidei; G., Bove; S., Cerilli; S., Catania; C., Ajassa; A., Ganau; L., Cristiano; A., Mazza; A., Di Palma; F., Mignone; C., Riva; C., Scorfaro; V., Portelli; M., Rabusin; A., Pellegatta; M., Molesini
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/522621
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