July 20, 2006

Study Confirms Treatment Benefit for Children

Adults are not the only HIV-positive people who benefit significantly from anti-HIV drug treatment. According to the results of large study, HIV-positive children are also experiencing far fewer opportunistic infections (OIs) than they were prior to the availability of combination therapy. The study, conducted by the Pediatric AIDS Clinical Trials Group (ACTG) of the National Institutes of Health, is the first to look at the changing rates of OIs among children since combination treatment became the standard-of-care approximately ten years ago.

Results from PACTG study 219C included 2,767 children who were enrolled between September 2000 and December 2004. The experiences of the children in PACTG 219C – meaning the incidence, or number, of new opportunistic infections reported – were compared to those of 3,3331 HIV-positive children enrolled in 13 other PACTG studies conducted between October 1988 and August 1998 (the years before combination anti-HIV treatment became the norm).

According to the study results, published in the July 19, 2006, issue of the Journal of the American Medical Association (JAMA), approximately 90% of the children enrolled were infected with HIV around the time of birth. Fifty-two percent of the study participants were girls and 59% were black. On average, the children were 8.2 years of age at the time of enrollment and were followed in the study for approximately 3.4 years.

During the study, 395 children – 14% of the study population – experienced at least one OI. The most common infections among the children were bacterial pneumonia, herpes zoster, fungal infections of the skin (dermatophyte infections), and thrush (oral candidiasis).

Compared to the children in earlier PACTG studies, the children in PACTG 219C were significantly more likely to living OI-free. Cases of bacterial pneumonia, herpes zoster, dermatophyte infections, and oral candidiasis were all higher in the pre-combo therapy years. Rates of other infections, including MAC, CMV, and TB, were also higher in children prior to the increased use of pediatric combination treatment. In fact, in PACTG 219C, rates of these other life-threatening OIs were very low.

While the study authors note that children receiving combination anti-HIV treatment are still at risk for disease-causing infections – for many of the same reasons as HIV-positive results on treatment (e.g., poor adhere and drug resistance) – they also stress that OIs are now uncommon in children and infection rates continue to be lower than those reported before combination therapy became the mainstay pediatric option.

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