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Interuption in baby
Mar 8, 2003
Dear Dr.s,
We have decided to interupt ARV treatment on our 18 month old baby. She has always been on ARV since birth (AZT, 3TC and NLF).
At age 13 months blood work was: CD4 = 36, 2814; VL <50. That was in October 2002.
We interupted treatment at 15 months old in December, 2002.
Just got back results from blood taken at age 17 months (2 months after start of interuption). CD4= 15, 1916; VL 471,000.
This is quite a drop in percent and increase in VL, but her CD4 count is still quite high. Our doctor says we should check CD4 again in a couple weeks, but start bactrim right away. What does this mean in terms of imuno depression having CD4 at 15 but with high CD4 count? What can we expect in two weeks or in another 2 months say for instance. Any other advise would be greatly appreciated.
Thank you ahead
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Response from Dr. Luzuriaga
You don't mention your reasons for wanting to interrupt therapy in your child but it is not a strategy that I generally advise. Experience has shown us that early therapy can do very well for children by controlling viral replication and preventing damage to their immune system. However, we also know that infants don't make immune responses to HIV in the same way that adults to, so it isn't surprising to me that your child's RNA has gone up and CD4 has gopne down off therapy. Unfortunately, prolonged therapy is probably the only way to keep your child's immune system at present. There are some trials in clinical trials proposed for children to see whetehr early therapy followed by HIV vaccination will hep them to control the virus better, but the results of these studies won't be available for a at least couple of years.
At this point, I would recommend that you resume therapy for your child. The viral load is very high. Even with a total CD4 count of 1900, the %CD4 of 15 is very troubling and, if reconfirmed within a week or so, indicates immune damage.
KL
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