Journal article
CD4+ cell count recovery following initiation of HIV antiretroviral therapy in older childhood and adolescence
- Abstract:
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Objective
To investigate CD4þ cell count recovery following ART initiation in perinatally HIV-infected children diagnosed in later childhood.
Design
Observational prospective cohort study of newly diagnosed children aged 6–15 in Harare, Zimbabwe.
Methods
Participants were enrolled into a cohort at seven primary healthcare clinics between January 2013 and January 2015. ART was initiated according to national guidelines and CD4þ cell counts were performed 6-monthly over 18 months. The relationship between CD4þ cell count and time on ART was investigated using regression analysis with fixed (population) and random (individual) effects, and age at ART initiation as a covariate.
Results
Of the 307 participants who initiated ART, the median age at initiation was 11.7 years (interquartile range 9.6–13.8). The addition of an individual intercept and slope as random effects significantly improved the model fit compared with a fixed effects-only model. CD4þ response (using a square-root transformation) was best modelled using a two-knot linear spline, with significant effects of time on ART and age at ART initiation. Younger children had a higher CD4þ cell count at ART initiation (-17.9 cells/ml per year of age), an accelerated increase during the first 3 months on ART (-38.9 cells/ml per year of age at day 84), and a sustained higher CD4þ cell count.
Conclusion
Earlier ART initiation in older children is associated with accelerated CD4þ cell count recovery and lasting immune reconstitution. Our findings support WHO guidance recommending ART initiation in all children, irrespective of disease stage and CD4þ cell count.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 263.9KB, Terms of use)
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- Publisher copy:
- 10.1097/QAD.0000000000001905
Authors
- Publisher:
- Lippincott, Williams and Wilkins
- Journal:
- AIDS More from this journal
- Volume:
- 32
- Issue:
- 14
- Pages:
- 1977-1982
- Publication date:
- 2018-06-20
- Acceptance date:
- 2018-05-11
- DOI:
- EISSN:
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1473-5571
- ISSN:
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0269-9370
- Pmid:
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29927784
- Language:
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English
- Keywords:
- Pubs id:
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pubs:859853
- UUID:
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uuid:545acf4d-c4bf-411b-a363-e2b6f36916ed
- Local pid:
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pubs:859853
- Source identifiers:
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859853
- Deposit date:
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2018-09-12
- ARK identifier:
Terms of use
- Copyright holder:
- Simms et al
- Copyright date:
- 2018
- Notes:
- Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
- Licence:
- CC Attribution (CC BY)
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