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Response to planned treatment interruptions in HIV infection varies across childhood.

机译：对计划中的艾滋病毒感染治疗中断的反应因儿童而异。

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OBJECTIVE: To evaluate clinical, immunological and virological consequences of CD4-guided antiretroviral therapy (ART) planned treatment interruptions (PTIs) compared with continuous therapy in children with chronic HIV infection in the Paediatric European Network for Treatment of AIDS 11 trial. DESIGN: This was a multicentre, 72-week, open, randomized, phase II trial. METHODS: One hundred and nine children with HIV-RNA below 50 copies/ml and CD4% of at least 30% (2-6 years) or at least 25% and CD4 cell count of at least 500 cells/microl (7-15 years) were randomized to continuous therapy (53) or PTI (56). In PTI, ART was restarted if confirmed CD4% was less than 20% or more than 48 weeks had been spent off ART. The primary outcome was Centers for Disease Control and Prevention (CDC) stage C event, death or CD4% less than 15% (and CD4 cell count less than 200 cells/microl for children aged 7-15 years). RESULTS: At baseline, median (interquartile range) age was 9 (6-12) years, CD4% 37% (33-41), CD4 cell count 966 (793-1258) cells/microl, nadir CD4% before combination ART 18% (10-27), time on ART 6 (3-6) years and 26% were CDC stage C. After median (range) 130 (33-180) weeks of follow-up, 4 versus 48% of time was spent off ART in continuous therapy and PTI, respectively. No child died or had a new CDC stage C event; one (2%) continuous therapy versus four (7%) PTI children had a primary outcome based on CD4%/cell count (P = 0.2). Lower nadir CD4% predicted faster CD4% decline after stopping ART. Younger age and higher nadir CD4% predicted being off ART for at least 48 weeks and better CD4% recovery following PTI. CONCLUSION: In this first paediatric trial of PTI, there were no serious clinical outcomes. Younger children had better CD4% recovery after PTIs. Immunology substudies and long-term follow-up in Paediatric European Network for Treatment of AIDS 11 trial are ongoing. Further research into the role of treatment interruption in children is required, particularly, as guidelines now recommend early ART for all infected infants.
机译：目的：为了评估CD4引导的抗逆转录病毒疗法（ART）计划中的治疗中断（PTI）与持续治疗对儿童慢性欧洲感染的儿童的临床，免疫和病毒学后果，这在欧洲儿科爱滋病治疗网络11试验中进行了比较。设计：这是一项多中心，为期72周的开放，随机，II期临床试验。方法：109名儿童的HIV-RNA低于50拷贝/毫升，CD4％至少为30％（2-6岁），或者至少25％，CD4细胞数至少为500细胞/微升（7-15）年）随机分为连续治疗（53）或PTI（56）。在PTI中，如果确诊的CD4％少于20％或超过48周已花费ART，则重新开始ART。主要结果是疾病控制和预防中心（CDC）的C期事件，死亡或CD4％小于15％（对于7-15岁的儿童，CD4细胞计数小于200个细胞/微升）。结果：在基线时，联合使用ART 18之前，中位（四分位间距）年龄为9（6-12）岁，CD4％37％（33-41），CD4细胞数966（793-1258）细胞/微升，最低CD4％。 ％（10-27），接受ART 6（3-6）年的时间和26％为CDC C期。在中位（范围）130（33-180）周的随访后，花费了4％至48％的时间在连续治疗和PTI中分别停用ART。没有儿童死亡或有新的CDC C期事件;根据CD4％/细胞计数，一（2％）持续治疗与四（7％）PTI儿童的主要结局是一致的（P = 0.2）。最低天底CD4％预测停止ART后CD4％下降更快。年龄较小和最高天底CD4％的患者预计将在至少48周内停用ART，并在PTI后恢复更好的CD4％。结论：在PTI的第一项儿科试验中，没有严重的临床结果。年龄较小的儿童在接受PTI后CD4％的恢复更好。欧洲儿科艾滋病治疗网络11的免疫学研究和长期随访正在进行中。尤其需要进一步研究中断治疗在儿童中的作用，因为指南现在建议对所有感染婴儿进行早期抗逆转录病毒治疗。

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    《AIDS》 |2010年第2期|共11页
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    Anonymous;

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  • 正文语种 eng
  • 中图分类 传染病;
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