Predictors of faster virological suppression in early treated infants with perinatal HIV from Europe and Thailand The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) and Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies (EPIICAL) study groups

被引：13

作者：

Chan, Man K. ^{[1
]}

Goodall, Ruth ^{[1
]}

Judd, Ali ^{[1
]}

Klein, Nigel ^{[11
,34
]}

Chiappini, Elena ^{[35
]}

Klimkait, Thomas ^{[36
]}

Ngo-Giang-Huong, Nicole ^{[37
]}

Palma, Paolo ^{[38
]}

Rossi, Paolo ^{[38
]}

Thorne, Claire ^{[34
]}

Turkova, Anna ^{[1
]}

Zangari, Paola ^{[38
]}

Rojo, Pablo ^{[43
]}

Babiker, Abdel G. A. ^{[1
]}

Fraaij, Pieter L. ^{[39
,40
]}

Pajkrt, Dasja ^{[41
]}

Marques, Laura ^{[2
,42
]}

Collins, Intira J. ^{[1
]}

Gibb, Diana M. ^{[1
]}

Gonzalez-Tome, Maria, I ^{[43
]}

Ramos, Jose T. ^{[45
]}

Navarro, Maria L. ^{[44
]}

Noguera-Julian, Antoni ^{[46
]}

Warszawski, Josiane ^{[47
]}

Koenigs, Christoph ^{[48
]}

Spoulou, Vana ^{[49
]}

Prata, Filipa ^{[3
,50
]}

Goetghebuer, Tessa ^{[4
,51
]}

Galli, Luisa ^{[52
]}

Naver, Lars ^{[5
,6
]}

Giaquinto, Carlo ^{[7
,53
]}

Marczynska, Magdalena ^{[54
]}

Okhonskaia, Liubov ^{[8
]}

Malyuta, Ruslan ^{[55
]}

Volokha, Alla ^{[9
,56
]}

Ene, Luminita ^{[10
,57
]}

Gibb, Diana ^{[11
]}

Watters, Sarah ^{[11
]}

Chan, Man ^{[11
]}

McCoy, Laura ^{[11
]}

Babiker, Abdel ^{[11
]}

Marcelin, Anne-Genevieve ^{[12
]}

Calvez, Vincent ^{[12
]}

Angeles Munoz, Maria ^{[13
]}

Wahren, Britta ^{[5
]}

Foster, Caroline ^{[14
]}

Cotton, Mark ^{[15
]}

Robb, Merlin

Ananworanich, Jintanat ^{[16
]}

Claiden, Polly ^{[17
]}

机构：

[1] UCL, Inst Clin Trials & Methodol, MRC, Clin Trials Unit, 90 High Holborn,2nd Floor, London WC1V 6LJ, England

[2] Ctr Hosp Porto, Porto, Portugal

[3] Hosp Santa Maria CHLN, Lisbon, Portugal

[4] Hosp St Pierre Paediat Cohort, Brussels, Belgium

[5] Karolinska Inst, Stockholm, Sweden

[6] Univ Hosp, Stockholm, Sweden

[7] Paediat European Network Treatment AIDS PENTA, Rome, Italy

[8] Republican Hosp Infect Dis, St Petersburg, Russia

[9] Ukraine Paediat HIV Cohort Study, Odessa, Ukraine

[10] Victor Babes Hosp Cohort, Bucharest, Romania

[11] UCL, London, England

[12] Univ Paris 06, Paris, France

[13] Hosp Gen Univ Gregorio Maranon, Serv Madrileno Salud, Madrid, Spain

[14] Imperial Coll Healthcare NHS Trust, London, England

[15] Stellenbosch Univ, Fac Med & Hlth Sci, Stellenbosch, South Africa

[16] Henry M Jackson Fdn Adv Mil Med, Bethesda, MD USA

[17] HIV I Base, London, England

[18] Univ KwaZulu Natal, Africa Ctr, Durban, South Africa

[19] Johns Hopkins Univ, Baltimore, MD 21218 USA

[20] Univ Utrecht, Utrecht, Netherlands

[21] Thai Red Cross AIDS Res Ctr, Bangkok, Thailand

[22] Consorzio Valutaz Biol & Farmacol, Pavia, Italy

[23] Univ Massachusetts, Sch Med, Worcester, MA USA

[24] Univ Montreal, Ctr Hosp Univ Montreal, Ctr Rech, Montreal, PQ, Canada

[25] Case Western Reserve Univ, Cleveland, OH 44106 USA

[26] Univ Roma Tor Vergata, Rome, Italy

[27] Columbia Univ, New York, NY USA

[28] Univ Witwatersrand, Johannesburg PHRU, Johannesburg, South Africa

[29] Childrens Hosp Bambino Gesu, Rome, Italy

[30] Univ Miami, Miller Sch Med, Coral Gables, FL 33124 USA

[31] Univ Complutense, Hosp 12 Octubre, Madrid, Spain

[32] Fundacao Ariel Glaser SIDA Pediat, Maputo, Mozambique

[33] Fundacao Manhica, Manhica, Mozambique

[34] UCL Great Ormond St Inst Child Hlth, London, England

[35] Univ Florence, Florence, Italy

[36] Univ Basel, Basel, Switzerland

[37] Chiang Mai Univ, Fac Med Sci, MI 174 PHPT, Chiang Mai, Thailand

[38] Childrens Hosp Bambino Gesu, Acad Dept Pediat DPUO, Res Unit Congenital & Perinatal Infect, Rome, Italy

[39] Erasmus MC, Dept Virosci, Rotterdam, Netherlands

[40] Erasmus Med Ctr Sophia, Dept Pediat, Subdiv Infect Dis & Immunol, Rotterdam, Netherlands

[41] Univ Amsterdam, Amsterdam UMC, Emma Childrens Hosp, Dept Pediat Infect Dis, Amsterdam, Netherlands

[42] Porto Cent Hosp, Pediat Dept, Paediat Infect Dis & Immunodeficiencies Unit, Porto, Portugal

[43] Hosp Doce Octubre, Peadiatr HIV & Infect Dis Dept, Madrid, Spain

[44] Hosp Univ Gregorio, Pediat Infect Dis Unit, Madrid, Spain

[45] Hosp Clin Univ San Carlos, Paediat Dept, Madrid, Spain

[46] Univ Barcelona, Hosp St Joan de Deu, Serv Pediat, Unitat Infectol, Barcelona, Spain

[47] INSERM, Paris, France

[48] Goethe Univ, Univ Hosp Frankfurt, Dept Paediat, Frankfurt, Germany

[49] Univ Athens, Dept Infect Dis, Athens, Greece

[50] Hosp Santa Maria, Lisbon, Portugal

来源：

AIDS | 2019年 / 33卷 / 07期

基金：

英国医学研究理事会;

关键词：

early combination antiretroviral therapy; infants; perinatal HIV; predictors; virological suppression; EARLY ANTIRETROVIRAL THERAPY; HIV-1-INFECTED INFANTS; AGE; RESPONSES; CELLS; RNA;

D O I：

10.1097/QAD.0000000000002172

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective: To identify predictors of faster time to virological suppression among infants starting combination antiretroviral therapy (cART) early in infancy. Design: Cohort study of infants from Europe and Thailand included in studies participating in the European Pregnancy and Paediatric HIV Cohort Collaboration. Methods: Infants with perinatal HIV starting cART aged less than 6 months with at least 1 viral load measurement within 15 months of cART initiation were included. Multi-variable interval-censored flexible parametric proportional hazards models were used to assess predictors of faster virological suppression, with timing of suppression assumed to lie in the interval between last viral load at least 400 and first viral load less than 400 copies/ml. Results: Of 420 infants, 59% were female and 56% from Central/Western Europe, 26% United Kingdom/Ireland, 15% Eastern Europe and 3% Thailand; 46 and 54% started a boosted protease inhibitor-based or nonnucleoside reverse transcriptase inhibitor-based regimen, respectively. At cART initiation, the median age, CD4(+) % and viral load were 2.9 [interquartile range (IQR): 1.4-4.1] months, 34 (IQR: 24-45)% and 5.5 (IQR: 4.5-6.0) log(10) copies/ml, respectively. Overall, an estimated 89% (95% confidence interval: 86-92%) achieved virological suppression within 12 months of cART start. In multivariable analysis, younger age [adjusted hazard ratio (aHR): 0.84 per month older; P < 0.001], higher CD4(+) % (aHR: 1.11 per 10% higher; P=0.010) and lower log(10) viral load (aHR: 0.85 per log(10) higher; P < 0.001) at cART initiation independently predicted faster virological suppression. Conclusion: We observed a significant independent effect of age at cART initiation, even within a narrow 6 months window from birth. These findings support the earliest feasible cART initiation in infants and suggest that early therapy influences key virological and immunological parameters that could have important consequences for long-term health. Copyright (C) 2019 The Author(s). Published by Wolters Kluwer Health, Inc.

引用

页码：1155 / 1165

页数：11

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