Long-term Outcomes of HAART in Children and Adolescents with HIV

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Previous observational studies have shown that highly active antiretroviral therapy (HAART) is associated with improved survival among HIV-infected children and adolescents, but such studies have had limited follow-up.

Given that HIV infection is chronic and that exposure to antiretroviral drugs is likely to be life-long, researchers write in the February 15, 2008, issue of Clinical Infectious Diseases, there is a need to evaluate the long-term effects of HAART on survival in this population.

The authors analyzed 1236 perinatally infected children and adolescents who were on study or enrolled after January 1996 in the U.S. multicenter Pediatric AIDS Clinical Trials Group 219/219C trial. The patients were not receiving HAART at baseline.

Participants were prospectively observed for a maximum of 10 years through June 2006. A weighted Cox regression model was used to estimate the effect of HAART on survival, appropriately adjusted for time-varying confounding by severity.

Results

• By the end of the 10-year follow-up period (median duration of follow-up 6.3 years; interquartile range 4.3-9.8 years), 70% of participants had started HAART.

• Lower CD4 cell percentages, lower total lymphocyte counts, and lower albumin levels were associated with an increased probability of initiating HAART.

• A total of 85 deaths were observed during follow-up.

• The mortality hazard ratio associated with HAART, compared with non-HAART regimens, was 0.24 after adjusting for disease severity (95% CI 0.11-0.51).

Conclusion

"The use of HAART was highly effective in reducing mortality during the period 1996-2006 among children and adolescents infected with HIV," the investigators concluded. "With improved long-term survival, continued follow-up is necessary to evaluate the effects of prolonged use of HAART on potential adverse events, immune function, growth, sexual maturation, and quality of life in this population."

1/29/08

Reference
K Patel, MA Hernan MA, PL Williams, and others. Long-Term Effectiveness of Highly Active Antiretroviral Therapy on the Survival of Children and Adolescents with HIV Infection: A 10-Year Follow-Up Study. Clinical Infectious Diseases 46(4): 507-515. February 15, 2008.