Impact of highly active antiretroviral therapy (HAART) on clinical outcomes of vertically HIV-1 infected children

Introduction

The use of antiretroviral therapy produced a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 (HIV-1)-infected children.

Objectives

To update a previous epidemiological survey that demonstrated the benefits of HAART on the clinical outcome of HIV-1 vertically infected children.

Materials and methods

We carried out a retrospective observational survey involving 346 HIV-1 vertically infected children (≤17 years old) living in the Autonomic Community of Madrid. The analysis was stratified in 5 calendar periods (CP) on the basis of the changing antiretroviral treatment protocols: CP1 (80-89): not treatment was used in this period; CP2 (90-93): the standard of care was monotherapy with nucleoside analogue reverse-transcriptase inhibitor (NRTI); CP3 (94-96): when dual-NRTI therapy was administered; CP4 (97-98): the antiretroviral regiments was HAART with a combinations of three or more drugs; CP5 (99-06): when > 60% of children were on HAART and less than 10% were untreated. We assumed that vertical transmission occurred on the birth day. We calculated the mean CD4⁺ T cells count and log₁₀ viral load per year, and we studied their trend over time. Then, we estimated the Kaplan-Meier curve to analyze the occurrence of AIDS and death. Finally, we performed a Cox regression analysis to calculate the relative risk (RR) for absence of AIDS and survival.

Results

We observed an increase of the mean CD4⁺ T-cell percentage and a concomitant decrease of the plasma log₁₀ viral load since 1997. A total of 205 kids had a diagnosis of AIDS (59.2%) and 122 died (35.3%). The last two periods (CP4 and CP5) had significantly fewer AIDS cases compared to the previous (P<0.001); in particular, the relative risk of the CP5 compared to the CP1 was of 5.5 (95%CI: 3.60-8.51). In the CP5 there were less death cases compared with the other periods (P<0.01) and the RR was of 9.7 (95%CI: 3.49-27.2) compared to the CP1, when the event of death occurred in more than the 20% of the children.

Conclusions

We confirmed the benefits of HAART in reducing adverse clinical outcomes as AIDS and death in HIV-1 vertically infected children in our cohort of kids living in the Autonomic Community of Madrid.