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Predictors of faster virological suppression in early treated infants with perinatal HIV from Europe and Thailand The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) and Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies (EPIICAL) study groups

Authors :: Chan, Man K. Goodall, Ruth Judd, Ali Klein, Nigel and Chiappini, Elena Klimkait, Thomas Ngo-Giang-Huong, Nicole and Palma, Paolo Rossi, Paolo Thorne, Claire Turkova, Anna and Zangari, Paola Rojo, Pablo Babiker, Abdel G. A. Fraaij, Pieter L. Pajkrt, Dasja Marques, Laura Collins, Intira J. and Gibb, Diana M. Gonzalez-Tome, I, Maria Ramos, Jose T. and Navarro, Maria L. Noguera-Julian, Antoni Warszawski, Josiane and Koenigs, Christoph Spoulou, Vana Prata, Filipa Goetghebuer, Tessa Galli, Luisa Naver, Lars Giaquinto, Carlo and Marczynska, Magdalena Okhonskaia, Liubov Malyuta, Ruslan and Volokha, Alla Ene, Luminita Gibb, Diana Watters, Sarah and Chan, Man McCoy, Laura Babiker, Abdel Marcelin, Anne-Genevieve Calvez, Vincent Angeles Munoz, Maria Wahren, Britta Foster, Caroline Cotton, Mark Robb, Merlin and Ananworanich, Jintanat Claiden, Polly Pillay, Deenan and Persaud, Deborah De Boer, Rob J. Schroter, Juliane Anelone, Anet J. N. Puthanakit, Thanyawee Ceci, Adriana Giannuzzi, Viviana Luzuriaga, Kathrine Chomont, Nicolas Cameron, Mark and Cancrini, Caterina Yates, Andrew Kuhn, Louise Violari, Avy Otwombe, Kennedy Pepponi, Ilaria Rocchi, Francesca and Rinaldi, Stefano Tagarro, Alfredo Lain, Maria Grazia Vaz, Paula Lopez, Elisa Nhampossa, Tacita European Pregnancy Paediat HIV Coh Early-Treated Perinatally
Publication Year :: 2019
Abstract: Objective: To identify predictors of faster time to virological suppression among infants starting combination antiretroviral therapy (cART) early in infancy. Design: Cohort study of infants from Europe and Thailand included in studies participating in the European Pregnancy and Paediatric HIV Cohort Collaboration. Methods: 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. Multi-variable interval-censored flexible parametric proportional hazards models were used to assess predictors of faster virological suppression, with timing of suppression assumed to lie in the interval between last viral load at least 400 and first viral load less than 400 copies/ml. Results: 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) log(10) 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 log(10) viral load (aHR: 0.85 per log(10) higher; P < 0.001) at cART initiation independently predicted faster virological suppression. Conclusion: We observed a significant independent effect of age at cART initiation, even within a narrow 6 months window from birth. These findings support the earliest feasible cART initiation in infants and suggest that early therapy influences key virological and immunological parameters that could have important consequences for long-term health. Copyright (C) 2019 The Author(s). Published by Wolters Kluwer Health, Inc.