In the Journals

Younger age at ART initiation led to longer viral suppression

Longer duration of viral suppression was associated with younger age at combination ART initiation among children with perinatal HIV, according to study findings published in JAMA Pediatrics.

Deborah Persaud, MD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues assessed 144 adolescents with perinatal HIV enrolled in the Pediatric HIV/AIDS Cohort Study who were receiving durable combination ART. Study participants had a median age of 14.3 years at the end of follow-up and had been receiving combination ART for a median of 10.2 years.

For the 14 adolescents who achieved virologic control before 1 year of age, median age at combination ART initiation was 2.4 months. Fifty-three adolescents achieved virologic control between ages 1 to 5 years and had a median age of 1.9 years at ART initiation, compared with 77 children who achieved virologic control after age 5 years who had a median age of 5.6 years at ART initiation.

Children who achieved virologic control after age 5 years were more likely to have received non-combination ART regimens prior to combination ART initiation. These children took longer to achieve virologic control after beginning ART.

Younger age at virologic control was associated with higher plasma viral load concentrations (P=.007) and CD4 T-cell percentage (P=.07) at combination ART initiation.

Younger age at virologic control was significantly associated with longer duration of virologic control, the researchers wrote.

Median duration of virologic control from confirmed virologic suppression to end of follow-up was 11.8 years for children who achieved virologic control before 1 year of age, 9.6 years for children who achieved virologic control between ages 1 to 5 years and 4.4 years among children who achieved virologic control after age 5 years.

Children who achieved virologic control at younger ages had slightly higher percentages of reconstituted CD4 T-cells (P=.03), though there were no between-group difference in increases in median CD4 T-cell percentages from ART initiation to end of follow-up.

“With combination ART, perinatally HIV-infected children have the potential to survive to adulthood. This study adds evidence that early effective control of virus replication in perinatal infection with combination ART, along with prolonged virologic suppression, leads to substantially restricted HIV peripheral blood proviral reservoirs and makes these children and adolescents potential candidates for interventions examining HIV remission or cure,” the researchers concluded.

Disclosure: One researcher reports financial ties with Chimerix, BMS, Gilead, Gen-Probe, Mongram, Sirenas and Prism. The other researchers report no relevant financial disclosures.