Predictors of faster virological suppression in early treated infants with perinatal HIV from Europe and Thailand. AIDS
Chan et al. on behalf of the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) aimed to investigate predictors of faster virological suppression, focusing on infants with perinatal HIV initiating standard combination antiretroviral therapy (cART) living in Europe and Thailand. Infants with perinatal HIV starting cART aged less than 6 months with at least 1 viral load measurement within 15 months of cART initiation were included.
Of 420 infants, 59% were female and 56% from Central/Western Europe, 26% United Kingdom/Ireland, 15% Eastern Europe and 3% Thailand; 46 and 54% started a boosted protease inhibitor-based or nonnucleoside reverse transcriptase inhibitor based regimen, respectively. At cART initiation, the median age, CD4+ % and viral load were 2.9 [interquartile range (IQR): 1.4–4.1] months, 34% (IQR: 24–45) and 5.5 (IQR: 4.5–6.0) log10 copies/ml, respectively. Overall, an estimated 89% (95% confidence interval: 86–92%) achieved virological suppression within 12 months of cART start. In multivariable analysis, younger age [adjusted hazard ratio (aHR): 0.84 per month older; P<0.001], higher CD4+% (aHR: 1.11 per 10% higher; P=0.010) and lower log10 viral load (aHR: 0.85 per log10 higher; P<0.001) at cART initiation independently predicted faster virological suppression.
In conclusion, the study showed that effective treatment response was achieved in the majority of infants initiating cART within 6 months of life across Europe and Thailand. The currrent work identified the conditions needed to attain faster virological suppression in these infants, demonstrating that even amongst early treated infants, earlier cART initiation, higher baseline CD4+ % and lower baseline viral load independently predicted faster virological suppression. These results provide additional support for earlier cART initiation in infants with perinatal HIV and indicate that early treatment influences key virological and immunological parameters that could have important consequences for long-term health.