Objectives: To describe demographic and treatment characteristics of the Dutch vertically HIV-infected paediatric population from 1996 to 2012, and to investigate the long-term virological and immunological response to combination antiretroviral therapy (cART), with emphasis on the influence of age at cART initiation and initial CD4+ cell counts.
Design: Descriptive cohort study.
Methods: From 1996 to 2012, all paediatric HIV clinics in the Netherlands provided data on their HIV-infected population. Descriptive statistics, parametric and non-parametric comparative tests, and random-effects linear regression models were performed to investigate the different aspects of this cohort.
Results: A total of 229 vertically HIV-infected children were included. The majority of all mothers (64%) and almost half of the children (43%) originated from sub-Saharan Africa. Ritonavir-boosted lopinavir and efavirenz have replaced indinavir, nelfinavir and nevirapine as preferred first-line cART regimens. Long-term CD4+ T-cell reconstitution (with CD4+ cell counts corrected for age) was independent of age and CD4+ cell count at cART initiation. The decline in HIV viral load after cART introduction occurred faster over the studied time period. The percentage of children with an undetectable viral load rose substantially from 1996 to 2012. Mortality was 0.3 per 100 person-years.
Conclusion: A sustained immunological response in the Dutch paediatric HIV-infected population was independent of age as well as CD4+ cell count at cART initiation, despite a higher initial HIV viral load in the youngest children. The percentage of children with an undetectable HIV viral load rose substantially over the years and there was a low mortality rate in comparison with reports from other industrialized countries.
aDepartment of Paediatric Infectious Diseases, Emma Children's Hospital AMC
bHIV Monitoring Foundation, Amsterdam
cDepartment of Paediatrics, Sophia Children's Hospital, ErasmusMC
dDepartment of Paediatrics, Sophia Children's Hospital/Viroscience Lab, ErasmusMC, Rotterdam
eDepartment of Paediatrics, Wilhelmina Children's Hospital, Utrecht
fDepartment of Paediatrics, University of Groningen, University Medical Centre Groningen
gRadboud University Medical Centre, Nijmegen and the Nijmegen Institute for Infection, Inflammation and Immunity, The Netherlands.
*S.C. and C.S. contributed equally to the writing of this article.
Correspondence to S. Cohen, MD, Department of Paediatric Infectious Diseases, Emma Children's Hospital, AMC, Amsterdam, the Netherlands. Tel: +31 20 5665675; e-mail: S.Cohen@amc.nl
Received 15 February, 2013
Revised 22 May, 2013
Accepted 11 June, 2013