Worldwide, 700,000 infants are infected annually by HIV-1, most of them in resource-limited settings. Care for'these'children requires simple, inexpensive tests. We have evaluated HIV-1 p24 antigen for antiretroviral treatment (ART) monitoring in children. p24 by boosted enzyme-linked immunosorbent assay of heated plasma and HIV-1 RNA were measured prospectively in 24 HIV-1-infected children receiving ART. p24 and HIV-1 RNA concentrations and their changes between consecutive visits were related to the respective CD4+ changes. Age at study entry was 7.6 years; follow-up was 47.2 months, yielding 18 visits at an interval of 2.8 months (medians). There were 399 complete visit data sets and 375 interval data sets. Controlling for variation between individuals, there was a positive relationship between concentrations of HIV-1 RNA and p24 (P < 0.0001). While controlling for initial CD4+ count, age, sex, days since start of ART, and days between visits, the relative change in CD4+ count between 2 successive visits was negatively related to the corresponding relative change in HIV-1 RNA (P = 0.009), but not to the initial HIV-1 RNA concentration (P = 0.94). Similarly, we found a negative relationship with the relative change in p24 over the interval (P < 0.0001), whereas the initial p24 concentration showed a trend (P = 0.08). Statistical support for the p24 model and the HIV-1 RNA model was similar. p24 may be an accurate low-cost alternative to monitor ART in pediatric HIV-1 infection.
From the *Institute for Social and Preventive Medicine, University of Berne, Berne; †Swiss National Center for Retroviruses and ‡Division of Infectious Diseases, University Children s Hospital, University of Zurich, Zurich, Switzerland.
Received for publication October 28, 2005; accepted January 10, 2006.
This study has been financed in the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation. The members of the Swiss HIV Cohort Study and the Swiss Mother and Child HIV Study are: C. Aebi, M. Battegay, E. Bernasconi, J. Böni, H. Bucher, Ph. Bürgisser, S. Cattacin, M. Cavassini, J.-J. Cheseaux, G. Drack, R. Dubs, M. Egger, L. Elzi, P. Erb, M. Fischer, M. Flepp, A. Fontana, P. Francioli (president of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne), HJ. Furrer, A. Gayet-Ageron, S. Gerber, M. Gorgievski, H. Günthard, B. Hirschel, I. Hösli, M. Hüsler, L. Kaiser, Ch. Kahlert, O. Keiser, U. Karrer, C. Kind, Th. Klimkait, B. Ledergerber, B. Martinez, N. Müller, D. Nadal, M. Opravil, F. Paccaud, G. Pantaleo, L. Perrin, J.-C. Piffaretti, M. Rickenbach, C. Rudin (chairman of the MoCHiV Substudy, Basel UKBB, Römergasse 8, CH-4058 Basel), P. Schmid, D. Schultze, J. Schüpbach, R. Speck, P. Taffé, P. Tarr, A. Telenti, A. Trkola, P. Vernazza, R. Weber, A. Wechsler, D. Wunder, C.-A. Wyler, S. Yerly.
Reprints: Jörg Schüpbach, MD, Swiss National Center for Retroviruses, University of Zurich, Gloriastrasse 30/32, CH-8006 Zurich, Switzerland (e-mail: email@example.com).