Early versus Deferred Antiretroviral Multidrug Therapy in Infants Infected with HIV Type 1

Faye, Albert; Chenadec, Jérôme Le; Dollfus, Catherine; Thuret, Isabelle; Douard, Danielle; Firtion, Ghislaine; Lachassinne, E.; Lévine, Martine; Nicolas, J; Monpoux, Fabrice; Tricoire, J; Rouzioux, Christine; Tardieu, Marc; Mayaux, Marie Jeanne; Blanche, Stéphane

doi:10.1086/425739

Cited by 116 publications

(76 citation statements)

References 25 publications

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“…33 Successful viral suppression through HAART is able to restore CD4 + T-cells and to normalize the percentage of B-cell subsets in blood only when therapy is applied during primary infection. 34,35 In this respect, we and others have suggested that HAART should be applied early after birth in HIV-1 vertically infected children. An early initiation of HAART is associated with a normal development of the T-cell repertoire, and with preservation of high review review Killed/inactivated vaccines consist of viruses or bacteria that are grown in culture and then killed or inactivated by heat or formaldehyde.…”

Section: Immune Reconstitution and Vaccination Outcome In Hiv-1 Infecmentioning

confidence: 99%

Immune reconstitution and vaccination outcome in HIV-1 infected children

Cagigi

Cotugno

Giaquinto

et al. 2012

Human Vaccines & Immunotherapeutics

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Section: Immune Reconstitution and Vaccination Outcome In Hiv-1 Infecmentioning

confidence: 99%

Immune reconstitution and vaccination outcome in HIV-1 infected children

Cagigi

Cotugno

Giaquinto

et al. 2012

Human Vaccines & Immunotherapeutics

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“…Research associated with a low baseline CD4 cell count in both resource-rich 29,30 and lowincome countries. 9,10,12,13 Earlier access to treatment could prevent many deaths.…”

Section: M-f Anaky Et Al Paediatric Antiretroviral Therapy In Côte Dmentioning

confidence: 99%

Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

Mf¹,

Duvignac

Wemin³

et al. 2009

Bull. World Health Organ.

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Entry into the programmeThe Aconda programme adopted a comprehensive family-based approach. Health-care workers were trained to offer HIV testing to every pregnant woman attending antenatal clinics and to encourage HIV-infected mothers to bring their children and partners with them for testing and counselling. Each pregnant woman with an HIV infection was immediately referred for an adult consultation. She then received PMTCT therapy, either a short regimen or ART depending on her clinical and immunological status, and underwent assessment at both antenatal and adult clinics. 18Children aged ≤ 15 years entered the Aconda programme in one of two ways: (i) after referral for HIV testing at the age of ≥ 6 weeks because their mother had been diagnosed with HIV infection and had received PMTCT therapy, or (ii) after HIV testing at a paediatric clinic following presentation with AIDS-related symptoms, even if they had not been previously classified as exposed to or infected by HIV and even if their parents had not participated in the Aconda programme. Standardized paediatric follow-upThe Aconda paediatric HIV care package included systematic paediatric HIV testing which varied according to the child's age. In those aged ≥ 18 months, the standard serum testing algorithm comprised a series of two rapid HIV assays: the Determine ® HIV-1/2 assay (Inverness Medical, Bedford, United Kingdom of Great Britain and Northern Ireland) followed by the Genie II ® HIV-1/HIV-2 assay (Bio-Rad laboratories, MarneLa-Coquette, France). 19 Children aged < 18 months were diagnosed virologically using a TaqMan HIV-1, ribonucleic acid (RNA), real-time polymerase chain reaction test (Hoffmann-La Roche, Basel, Switzerland) with a threshold of 300 copies/ml. 20 Children were regarded as having HIV-1 infections if, at any age, they tested positive for HIV-1 RNA in plasma at least once or if, at age ≥ 18 months, they were positive for HIV-1 on serum testing. Children who tested negative but who were still breastfeeding were defined as HIV-undetermined and were retested 2 months after the cessation of breastfeeding or at 18 months. A negative diagnosis was regarded as definite if it was made at least 2 months after the cessation of breastfeeding and children with this diagnosis were excluded from the programme.All children with a confirmed HIV infection were seen monthly and had unrestricted free access to antiretroviral drugs and comprehensive care. 21 In all children, whether on ART or not, the CD4+ T lymphocyte (CD4 cell) count and CD4 cell percentage were measured every 6 months. Plasma viral load testing was not performed routinely after the diagnosis of HIV infection, even in children on ART. Pulmonary radiographs were available for children whose history and symptoms suggested tuberculosis.Children initiated ART if they were either at World Health Organization (WHO) HIV/AIDS clinical stage 3 or 4 or at clinical stage 1 or 2 with impaired immunity (i.e. a CD4 cell percentage ≥ 25 at age < 12 months, ≥ 20 at 12-35 months or ≥ 15 at ≥ 36 month...

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“…Anos 2000 em diante: a era dos resultados do tratamento rumo ao manejo das comorbidades Na última década, pesquisas demonstraram benefícios da introdução cada vez mais precoce da TARVC 21,22,23,24,25,26,27,28,29 , tornando necessária a ampliação do conhecimento do impacto dessa nova forma de tratamento na evolução clínica e na sobrevida dos pacientes pediátricos infectados pelo HIV. Além de se prestar para o dimensionamento das necessidades no que se refere à assistência e ao estabelecimento de políticas públicas, essa informação é fundamental para a avaliação das estratégias de intervenção que visam ao prolongamento com qualidade de vida desses pacientes.…”

Section: Década De 1990: Avanço No Conhecimento Da Doença E Tentativaunclassified

“…O impacto dessa nova abordagem na sobrevida dos pacientes pediátricos desencadeou importantes mudanças nos centros de atendimento especializado, com redimensionamento das diretrizes do tratamento, visando ao acesso e à adesão à terapia proposta 18,19,20 . Na última década, pesquisas na faixa etária pediátrica demonstram benefícios na introdução cada vez mais precoce da TARVC em crianças infectadas pelo HIV 21,22,23,24,25,26,27,28,29 .…”

Section: Introductionunclassified

Terapia antirretroviral em crianças e adolescentes infectados pelo HIV: o que sabemos após 30 anos de epidemia

et al. 2014

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Este estudo tem como objetivo avaliar o uso da terapia antirretroviral combinada em crianças e adolescentes com AIDS. Foram captados 247 resumos nos portais PubMed e LILACS, publicados entre 1983 e 2013, sendo utilizados 69 artigos para as referências bibliográficas. A atenção atribuída às pesquisas na faixa etária pediátrica durante os trinta anos de epidemia de AIDS se justifica por características imunológicas próprias, sendo a progressão da AIDS mais rápida em crianças que em adultos. Pesquisas recentes abordam estratégias de intervenção medicamentosa de alta potência antes do aparecimento dos sintomas iniciais. A introdução precoce da terapia antirretroviral combinada foi implantada com eficácia e segurança em populações com poucos recursos fixos, com melhora significativa da sobrevida desses pacientes. O desafio atual é lidar com uma doença crônica com intercorrências agudas. Novas pesquisas serão necessárias, atentando para as especificidades populacionais e particularizando as necessidades individuais dos pacientes pediátricos.

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Early versus Deferred Antiretroviral Multidrug Therapy in Infants Infected with HIV Type 1

Abstract: In this observational study, infants who received multidrug therapy before 6 months of age did not have the early-onset severe form of childhood HIV disease. Further studies are needed to find accurate early markers of disease progression in this age group.

Cited by 116 publications

References 25 publications

Immune reconstitution and vaccination outcome in HIV-1 infected children

Immune reconstitution and vaccination outcome in HIV-1 infected children

Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

Terapia antirretroviral em crianças e adolescentes infectados pelo HIV: o que sabemos após 30 anos de epidemia

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