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Long‐term clinical, virological and immunological outcomes following planned treatment interruption in HIV‐infected children

Freguja, R; Bamford, A; Zanchetta, M; Del Bianco, P; Giaquinto, C; Harper, L; Dalzini, A; ... De Rossi, A; + view all (2021) Long‐term clinical, virological and immunological outcomes following planned treatment interruption in HIV‐infected children. HIV Medicine , 22 (3) pp. 172-184. 10.1111/hiv.12986. Green open access

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Abstract

Objectives: Planned treatment interruption (PTI) of antiretroviral therapy (ART) in adults is associated with adverse outcomes. The PENTA 11 trial randomized HIV‐infected children to continuous ART (CT) vs. CD4‐driven PTIs. We report 5 years’ follow‐up after the end of main trial. / Methods: Post‐trial, all children resumed ART. Clinical, immunological, virological and treatment data were collected annually. A sub‐study investigated more detailed immunophenotype. CT and PTI arms were compared using intention‐to‐treat. Laboratory parameters were compared using linear regression, adjusting for baseline values; mixed models were used to include all data over time. / Results: In all, 101 children (51 CT, 50 PTI) contributed a median of 7.6 years, including 5.1 years of post‐trial follow‐up. Post‐trial, there were no deaths, one pulmonary tuberculosis and no other CDC stage B/C events. At 5 years post‐trial, 90% of children in the CT vs. 82% in the PTI arm had HIV RNA < 50 copies/mL (P = 0.26). A persistent increase in CD8 cells was observed in the PTI arm. The sub‐study (54 children) suggested that both naïve and memory populations contributed to higher CD8 cells following PTI. Mean CD4/CD8 ratios at 5 years post‐trial were 1.22 and 1.08 in CT and PTI arms, respectively [difference (CT – PTI) = −0.15; 95% CI: −0.34–0.05), P = 0.14]. The sub‐study also suggested that during the trial and at early timepoints after the end of the trial, reduction in CD4 in the PTI arm was mainly from loss of CD4 memory cells. / Conclusions: Children tolerated PTI with few long‐term clinical, virological or immunological consequences.

Type: Article
Title: Long‐term clinical, virological and immunological outcomes following planned treatment interruption in HIV‐infected children
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/hiv.12986
Publisher version: https://doi.org/10.1111/hiv.12986
Language: English
Additional information: Copyright © 2020 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: ARV, children, HIV, immunology, treatment interruption, virology
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10110963
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