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J AIDS Clin Res. 2016 Apr;7(4). pii: 565. doi: 10.4172/2155-6113.1000565. Epub 2016 Apr 14.

Frequent Episodes of Detectable Viremia in HIV Treatment-Experienced Children is Associated with a Decline in CD4+ T-cells Over Time.

Author information

1
Departments of Pediatrics and Pharmacology, Yale University School of Medicine, New Haven, USA.
2
Georgetown University, Washington, DC, USA.
3
Columbia University College of Physicians and Surgeons, New York, USA.
4
Tufts University, Medford, USA.
5
Department of Pediatrics, Yale University School of Medicine, New Haven, USA.
6
Ragon Institute and Harvard Medical School, Cambridge, MA.
#
Contributed equally

Abstract

BACKGROUND:

The clinical consequences of the magnitude and the duration of detectable viremia in HIV-infected children have not been well characterized. We examined the predictors and immunologic consequences over time of frequent episodes of detectable viremia in HIV-infected children followed at Yale-New Haven Hospital.

METHODS:

We analyzed the CD4+ T-cell and HIV viral load over a 19-year period (1996 to 2013) of 104 HIV-infected children enrolled in the Yale Prospective Longitudinal Pediatric HIV Cohort. Both CD4+ T-lymphocytes and HIV viral load were measured at clinic visits every 3 to 4 months. Longitudinal data analyses using polynomial random coefficients models were conducted to examine overtime changes in CD4+ T-cell counts by frequency of episodes of detectable viremia. Moreover, regression analyses using logistic regression models were used to assess the predictors of frequent episodes of detectable viremia.

RESULTS:

One hundred and four (104) HIV-infected children with more than one HIV viral load measurement between 1996 and November 2013 were included in the analysis. Over 80% (N=86) of the children had detectable viral load (HIV RNA viral load ≥50 copies/ml) during more than 50% of their clinic visits. Children with infrequent episodes of detectable viremia had significantly higher CD4+ T-cell counts overtime compared to those with frequent episodes of detectable viremia (P<0.0001).

CONCLUSIONS:

Both frequency and magnitude of episodes of detectable viremia had effect on CD4+ T-cells. Strict adherence to a treatment goal of undetectable HIV viremia in children is likely to be beneficial.

KEYWORDS:

CD4+ T-Cell; HIV-infected children; Transient viremia; Viral blips; Virologic failure

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