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The Body Covers: The 7th Conference on Retroviruses and Opportunistic Infections

Session 49
Immune Reconstitution in Pediatric HIV-1 Infection

Coverage provided by Mark Holodniy, M.D.

January 31, 2000

Poster 319: Immune Reconstitution and Viral Load Response In Antiretroviral naïve Vertically HIV-Infected Children Enrolled In The PENTA 5 Trial

Poster 319 looked at the T-cell and viral load responses to HAART treatment in children enrolled in the European PENTA 5 study. 25 children were randomized to a double nucleoside reverse transcriptase inhibitor (NRTI) arm (ZDV/3TC, ZDV/ABC, 3TC/ABC), with or without nelfinavir. Mean age was 5.7 years. Baseline VL was over 100,000 copies/ml and CD4 count was 403 (14%). Follow-up was 63 weeks. The number of memory and naïve T-cells were monitored during the study. Viral load fell by 3 logs by week 24 and was sustained at week 48 in over 80% of children. CD4 count increased by 250, which was also sustained at 48 weeks. 71% of the cells were naïve. The percentage of naïve cell increase was inversely correlated with age. That is the younger the patient, the higher the number of naïve cells were found. This study again shows the excellent response to HAART that children can have. And unlike adults where the early and larger increase is primarily in memory T-cells, in young children the response is mainly naïve cells. The authors speculate that this may be related to children having more intact thymus function to process naïve cells more efficiently.

Poster 324: Response to Childhood Immunizations in HIV-Infected Children Treated with Potent Combination Antiretroviral Therapy

Poster 324 looked at the question of whether HAART therapy in children could help improve the response to regular childhood immunizations in HIV infected children. 22 children, who were under 16 years old (mean 7 years), were enrolled. Children had to have been on >6 months of HAART (median 18 months). The mean increase in CD4 was 10%. All children had a VL of <50 copies/ml. Titers were measured for measles, mumps, rubella (MMR), diphtheria/pertussis (DtaP), tetanus (Td), and hemophilus (HIB). Children who had undetectable titers to any of these vaccines were revaccinated and retested for the presence of antibody after four weeks. Most had protective antibodies to HIB at baseline. Less than one third had antibodies to MMR or tetanus. After reimmunization, >80% developed detectable antibodies to these agents. In addition, immunoglobulin subclasses were also looked at. Total levels of IgG, IgM, and IgA had decreased after HAART therapy, suggesting decreased polyclonal activation of B cells with therapy. The results from this study suggest that children can achieve or re-achieve detectable levels of protective antibodies following revaccination during HAART. Thus consideration should be given to revaccinating children with vaccines against agents to which they do not have detectable antibodies.

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