Vigana A, Pirollo M, Sala N, Bricalli D, Saresella M, Dally L, Principi N, Vella S; University of Milan, Italy.
We evaluated the long-term outcome (median:18 months) during potent antiretroviral therapy of 25 vertically HIV-infected children with severe or moderate immunodeficiency. Sixteen CDC class 2 and eight CDC class 3 children (mean age: 9.8 years) - with comparable prior nucleoside experience (ZDV ± ddI) - were switched to a triple combination of d4T/3TC/INDINAVIR. The children were followed for a median time of 18 months. T-cell subpopulations, PBMCs proliferative responses to recall antigens, DHT skin test responses plasma HIV-RNA and clinical data were assessed before and every 3 months during therapy. Total CD4+ and naïve CD4+ (CD45RA+62+) cells showed a progressive large increase irrespective of CDC class at baseline. Total CD8+ cells remained quite stable in both CDC classes, but the percentage of CD8+CD38+ cells significantly declined. PBMCs proliferative response and DTH skin test response improved significantly during therapy. Ninety percent of children were still below 80 copies/ml of HIV-RNA in plasma after 18th month of therapy. No child had disease progression or occurrence of OIs. Our data are suggestive of a sustained benefit of potent antiretroviral therapy in HIV-infected children. The excellent recovery of the immune function may have a role in the sustained maximal suppression of HIV viremia observed in our children.
Keywords: AEGIS, HIV, Stavudine, Didanosine, Indinavir, Zidovudine, Anti-HIV Agents, Lamivudine, Reverse Transcriptase Inhibitors, HIV Infections, HIV Protease Inhibitors, Disease Progression, Centers for Disease Control and Prevention (U.S.), Antigens, CD4, T-Lymphocytes, United States, Child, Human, therapy, drug therapy, AIDS
