Incomplete immune reconstitution despite virologic suppression in HIV-1 infected children and adolescents

Paul Krogstad, Kunjal Patel, Brad Karalius, Rohan Hazra, Mark J. Abzug, James Oleske, George R. Seage, Paige L. Williams, William Borkowsky, Andrew Wiznia, Jorge Pinto, Russell B. Van Dyke

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17 Scopus citations


Objectives: Some perinatally infected children do not regain normal CD4+ T-cell counts despite suppression of HIV-1 plasma viremia by antiretroviral therapy (ART). The frequency, severity and significance of these discordant treatment responses remain unclear. Design: We examined the persistence of CD4+ lymphocytopenia despite virologic suppression in 933 children (-5 years of age) in the USA, Latin America and the Caribbean. Methods: CD4+ T-cell trajectories were examined and Kaplan-Meier methods used to estimate median time to CD4+ T-cell count at least 500 cells/ml. Results: After 1 year of virologic suppression, most (99%) children achieved a CD4+ T-cell count of at least 200 cells/ml, but CD4+ T-cell counts remained below 500 cells/ml after 1 and 2 years of virologic suppression in 14 and8%of children, respectively.Median times to first CD4+ T-cell count at least 500 cells/ml were 1.29, 0.78 and 0.46 years for children with less than 200, 200-349 and 350-499 cells/ml at the start of virologic suppression. New AIDS-defining events occurred in nine children, including four in the first 6 months of virologic suppression. Other infectious and HIV-related diagnoses occurred more frequently and across a wide range of CD4+ cell counts. Conclusion: ART improved CD4+ cell counts in most children, but the time to CD4+ cell count of at least 500 cells was highly dependent upon baseline immunological status. Some children did not reach a CD4+ T-cell count of 500cells/ml despite 2 years of virologic suppression. AIDS-defining events occurred in 1% of the population, including children in whom virologic suppression and improved CD4+ T-cell counts were achieved.

Original languageEnglish (US)
Pages (from-to)683-693
Number of pages11
Issue number6
StatePublished - Mar 27 2015

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


  • AIDS
  • Antiretroviral therapy
  • HIV
  • Immune reconstitution
  • Opportunistic infections
  • Paediatrics


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