Abstract
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. 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. 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). 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.
Highlights
The clinical consequences of the magnitude and the duration of detectable viremia in HIV-infected children have not been well characterized
While some studies have reported that transient viremia are of no clinical significance [16,22,23], others studies have reported an association between transient viremia and virologic failure [9,24,25], depletion of CD4+ T-cells [26], and emergence of drug resistant viruses [20,21]
The study participants were divided into two categories based on the frequency of episodes of detectable viremia during scheduled clinic visits
Summary
The clinical consequences of the magnitude and the duration of detectable viremia in HIV-infected children have not been well characterized. Isolated episodes of plasma HIV RNA >500 copies/mL (i.e., transient viremia) followed by return to levels of viral suppression often observed in adults and children on ART are not considered as virologic failure [9,12,13]. While some studies have reported that transient viremia are of no clinical significance [16,22,23], others studies have reported an association between transient viremia and virologic failure [9,24,25], depletion of CD4+ T-cells [26], and emergence of drug resistant viruses [20,21]
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