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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