Dataset Information

CD4+ cell count recovery following initiation of HIV antiretroviral therapy in older childhood and adolescence.

ABSTRACT:

Objective

To investigate CD4 cell count recovery following ART initiation in perinatally HIV-infected children diagnosed in later childhood.

Design

Observational prospective cohort study of newly diagnosed children aged 6-15 in Harare, Zimbabwe.

Methods

Participants were enrolled into a cohort at seven primary healthcare clinics between January 2013 and January 2015. ART was initiated according to national guidelines and CD4 cell counts were performed 6-monthly over 18 months. The relationship between CD4 cell count and time on ART was investigated using regression analysis with fixed (population) and random (individual) effects, and age at ART initiation as a covariate.

Results

Of the 307 participants who initiated ART, the median age at initiation was 11.7 years (interquartile range 9.6-13.8). The addition of an individual intercept and slope as random effects significantly improved the model fit compared with a fixed effects-only model. CD4 response (using a square-root transformation) was best modelled using a two-knot linear spline, with significant effects of time on ART and age at ART initiation. Younger children had a higher CD4 cell count at ART initiation (-17.9?cells/?l per year of age), an accelerated increase during the first 3 months on ART (-38.9?cells/?l per year of age at day 84), and a sustained higher CD4 cell count.

Conclusion

Earlier ART initiation in older children is associated with accelerated CD4 cell count recovery and lasting immune reconstitution. Our findings support WHO guidance recommending ART initiation in all children, irrespective of disease stage and CD4 cell count.

SUBMITTER: Simms V

PROVIDER: S-EPMC6125740 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

CD4+ cell count recovery following initiation of HIV antiretroviral therapy in older childhood and adolescence.

Simms Victoria V Rylance Sarah S Bandason Tsitsi T Dauya Ethel E McHugh Grace G Munyati Shungu S Mujuru Hilda H Rowland-Jones Sarah L SL Weiss Helen A HA Ferrand Rashida A RA

AIDS (London, England) 20180901 14

<h4>Objective</h4>To investigate CD4 cell count recovery following ART initiation in perinatally HIV-infected children diagnosed in later childhood.<h4>Design</h4>Observational prospective cohort study of newly diagnosed children aged 6-15 in Harare, Zimbabwe.<h4>Methods</h4>Participants were enrolled into a cohort at seven primary healthcare clinics between January 2013 and January 2015. ART was initiated according to national guidelines and CD4 cell counts were performed 6-monthly over 18 mont ...[more]

PMID: 29927784

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Project description:BackgroundThere is conflicting evidence on the immunologic benefit of treating helminth co-infections ("deworming") in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naïve individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.Methodology/principal findingsTo estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or non-receipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (? = 42.8; 95% CI, -2.1 to 87.7) or after the first year of ART (? = ?-9.9; 95% CI, -24.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (? = 63.0; 95% CI, 6.0 to 120.1) in females.Conclusions/significanceEmpiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naïve individuals, but suggest that certain sub-populations may benefit.

Dataset Information

CD4+ cell count recovery following initiation of HIV antiretroviral therapy in older childhood and adolescence.

Objective

Design

Methods

Results

Conclusion

Publications

CD4+ cell count recovery following initiation of HIV antiretroviral therapy in older childhood and adolescence.

Similar Datasets

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