Children with advanced disease who take HAART experience immune reconstitution

Children with HIV-1, who have moderate to severe advanced disease and who receive HAART can reconstitute their immune system to the same level seen in children with stable HIV-1 infection, according to a study reported in the October issue of the Pediatric Infectious Disease Journal.

Dr Alicia Johnston and colleagues at Duke University Medical Center, Durham, North Carolina, studied a cohort of 18 HIV-1-infected children, median age 7.4 years. Before these children started HAART, they had moderate to severe suppression of their immune systems as defined by the CDC, with CD4 counts <25% or CDC Category B or C disease. The children received HAART for between four and 33 months.

They were compared with 17 HIV-1-infected children, median age 7.9 years, who had no history of immunosuppression (CD4 > 25%) and no evidence of clinical disease. This second group of children was receiving a non-HAART regimen.

The researchers found that there was no difference in percent CD4+ or percent CD8+ T cells or in maturation markers between the two groups. However, in the group receiving HAART, there was significantly less CD4+ cell (p = 0.04) and CD8+ cell (p = 0.004) activation when compared with the children not having HAART.

Further, there was no statistical difference between the groups in T cell rearrangement excision circle production, indicative of recent thymic emigrants.

The researchers conclude that if future trials confirm that significant immune reconstruction can truly be achieved in children with clinically stable disease as well as those with advanced disease, then this information could be used either to support the use of HAART in all HIV-infected children or to support the view that delaying therapy results in impressive virologic, immunologic and clinical benefit.

Continued re-evaluation of the optimal use and timing of antiretroviral therapy in specific populations is needed to address this controversial issue, – they write.