More than half of a cohort of children born with HIV,
who never received highly active antiretroviral therapy (HAART) or
received only minimal therapy, continue to maintain stable CD4 cell
counts into adolescence and HIV RNA levels have declined as these
children enter their teen years, according to the findings of a small
study.
In the March issue of The Pediatric Infectious Disease Journal, Dr.
Juliana A. Ofori-Mante and colleagues at New York University School of
Medicine describe the natural history of HIV disease in a group of 20
children as they enter their second decade of life.
These children were born before the era of HAART and had received no
treatment or at most minimal therapy with one or two nucleosides.
In 9 of the 20 children, CD4 cell counts began to fall around the
time they entered puberty, but counts remained stable in 11 children.
Children who continue to have stable CD4 counts have also had
decreases in HIV RNA levels. In contrast, children whose CD4 cell
counts began to decline during puberty had no decrease in viral load.
The falling HIV RNA values in children with stable CD4 cell counts
indicate "improved virologic control despite no change in therapy," the
NYU researchers observe. "In our study cohort, viral load changes
appeared to be a predictive factor in terms of HIV progression."
Researchers are uncertain about what causes a nonprogressor to
change to a progressor, Dr. Ofori-Mante's team points out. For the 11
who have maintained stable CD4 cell counts, "How long these children
will continue to remain well is unknown."
Ped Infect Dis J 2007;26:217-220.
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