Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e513-e521 (doi:10.1542/peds.2007-1086)

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ARTICLE

Clinical Outcomes After an Unstructured Treatment Interruption in Children and Adolescents With Perinatally Acquired HIV Infection

Akihiko Saitoh, MD^a, Marc Foca, MD^b, Rolando M. Viani, MD^a, Susan Heffernan-Vacca, NP^b, Florin Vaida, PhD^c, Jorge Lujan-Zilbermann, MD^d, Patricia J. Emmanuel, MD^d, Jaime G. Deville, MD^e and Stephen A. Spector, MD^a

^a Division of Infectious Diseases, Department of Pediatrics
^c Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California
^b Division of Infectious Disease, Department of Pediatrics, Columbia University, New York, New York
^d Division of Infectious Diseases, Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida
^e Division of Infectious diseases, Department of Pediatrics, School of Medicine, University of California, Los Angeles, California

OBJECTIVE. An unstructured treatment interruption in children with perinatally acquired HIV infection is an issue with unresolved significance. The objective of this study was to investigate the actual prevalence and clinical outcomes of a treatment interruption in children and adolescents with perinatally acquired HIV-1 infection.

METHODS. Clinical data were analyzed for 72 children and adolescents who had HIV-1 infection and stopped their medications at 4 academic centers in the United States between January 2000 and September 2004.

RESULTS. Among 405 patients with perinatal HIV-1 infection, 72 (17.8%) experienced a treatment interruption during the observation period. The mean age of patients at the time of the treatment interruption was 12.8 years, and the mean length of the treatment interruption was 14 months. Medication fatigue was the most common reason for a treatment interruption. The CD4⁺ T-cell percentage nadir before the treatment interruption did not predict CD4⁺ T-cell percentage declines during the treatment interruption; however, the CD4⁺ T-cell percentage gain from nadir to the time of the treatment interruption predicted CD4⁺ T-cell percentage declines during the treatment interruption. During the median follow-up of 19 months (range: 6–48 months), 48 (67%) patients resumed antiretroviral medications. As expected, there was a continuous CD4⁺ T-cell percentage decrease and plasma HIV-1 RNA increase during the observation period. Overall, 7 (10%) patients were admitted to the hospital; 2 (3%) patients experienced an AIDS-defining illness.

CONCLUSIONS. An unstructured treatment interruption seems to be a major issue for youth with perinatally acquired HIV-1 infection. Patients who experienced the greatest rise in CD4⁺ T-cell percentage on treatment had the largest CD4⁺ T-cell percentage decline after the treatment interruption. Close monitoring is required when a treatment interruption occurs in children and adolescents with HIV infection.

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Key Words: treatment interruption • HIV-1 • children • adolescent • nadir CD4⁺ T-cell percentage • medication fatigue

Abbreviations: HAART—highly active antiretroviral therapy • TI—treatment interruption • CD4%—CD4⁺ T-cell percentage • NRTI—nucleoside reverse transcriptase inhibitor • NNRTI—non–nucleoside reverse transcriptase inhibitor • PI—protease inhibitor • PCP—Pneumocystis jiroveci pneumonia • CI—confidence interval

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Accepted Jul 19, 2007.

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