Long-term survival and immuno-virological response of African HIV-1-infected children to highly active antiretroviral therapy regimens

Background: In Africa, facing the scaling-up of HAART, there is an urgent need to monitor accurately the long-term benefits of these lifelong treatments. Methods: Survival and immuno-virological response were assessed for 78 children in the ANRS 1244/1278 Children's cohort (Abidjan, Cote d'Ivoire) who were enrolled from October 2000 for treatment with HAART and followed to September 2004. Initial HAART consisted of two nucleoside reverse transcriptase inhibitors with either nelfinavir (NFV) or efavirenz (EFV). For the comparison of immunological and virological responses, CD4 cell counts and HIV-1 RNA viral load were assessed by performing time-point specific and longitudinal data analysis. Results: At baseline, the median CD4 cell percentage was 7.5% and the median HIV-1 RNA viral load was 5.37 log(10) copies/ml. The survival probability was high (0.86 at month 42; 95% confidence interval, 0.77-0.92) with no difference according to whether the HAART regimen contained NFV or EFV. At 36 and 42 months of follow-up, an immune recovery was observed with median CD4 cell percentages reaching 23.1% and 24.8%, respectively, with no difference according to the HAART regimen (longitudinal data analysis). At the same time points, a sustained viral suppression was also obtained, with undetectable viral load achieving in 46.5% and 45.0%, respectively, regardless of whether the HAART regimen. Conclusion: This study demonstrates the durability of both clinical and biological response to HAART in African children. (c) 2006 Lippincott Williams & Wilkins.