Immune Reconstitution and Predictors of Virologic Failure in Adolescents Initiating HAART

The responses to HAART among HIV positive adolescents infected through risk behaviors are not well defined. The Pediatrics AIDS Clinical Trial Group 381 (PACTG 381) collected intensive immunologic and virologic data on youth naive to or with minimal exposure to antiretroviral therapy who began HAART. The study is published in the March 2006 issue of AIDS Research and Human Retroviruses.

Subjects were evaluated according to their weeks 16-24 virologic response. Comparisons with a cohort of HIV-uninfected adolescents from the REACH cohort were performed.
Results

Only 69 of 120 subjects (58%) achieved virologic suppression by weeks 16-24, whereas 55 of 69 (80%) demonstrated control to week 60.

Higher CD4+ naive T cells, higher CD8+ activated T cells and higher CD8+ naive T cells at weeks 16-24 in subjects with early viral success were predictive of subsequent failure.

By week 60, total CD4+ T cells remained significantly lower than in uninfected controls.

In conclusion, the authors write, "Adolescents beginning HAART achieve moderate rates of viral suppression by weeks 16-24. In those who do achieve early virologic control, suppression to week 60 is high although total CD4+ T cells remain significantly lower than in uninfected controls."

"Several T cell markers were predictive of subsequent virologic failure in subjects achieving short-term success. Further study is warranted to determine whether these predictors provide any benefit to clinical management."

03/20/06

Reference
B J Rudy and others (The Pediatric AIDS Clinical Trials Group 381 Study Team). Immune Reconstitution and Predictors of Virologic Failure in Adolescents Infected through Risk Behaviors and Initiating HAART: Week 60 Results from the PACTG 381 Cohort. AIDS Research and Human Retroviruses 22(3): 213-221. March 2006.