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Pattern and Predictors of Immunologic Recovery in Human Immunodeficiency Virus-Infected Children Receiving Non-Nucleoside Reverse Transcriptase Inhibitor-Based Highly Active Antiretroviral Therapy

Puthanakit, Thanyawee MD*†; Kerr, Stephen J. PhD†‡; Ananworanich, Jintanat MD, PhD†§; Bunupuradah, Torsak MD; Boonrak, Pitch MSc; Sirisanthana, Virat MD

The Pediatric Infectious Disease Journal: June 2009 - Volume 28 - Issue 6 - p 488-492
doi: 10.1097/INF.0b013e318194eea6
Original Studies

Background: Non-nucleoside reverse transcription inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART) is the recommended first-line regimen for children in Thailand. This study was aimed to assess pattern and predictors of immune recovery in antiretroviral-naive Thai children starting NNRTI-based HAART.

Methods: Records were extracted from clinical databases of 2 treatment cohorts in Thailand. The inclusion criteria were HIV-infected naive children who initiated NNRTI-based HAART when CD4 <25%. Immune recovery was defined as achieving a target CD4% of 25. The impact of age, gender, baseline clinical category, CD4 and HIV RNA titer, and regimen on immune recovery to weeks 96 was assessed using multiple logistic regression.

Results: There were 274 patients (52% females) with a median baseline age of 7 (Interquartile range [IQR]: 4–9) years and a median CD4% of 5 (IQR: 1–12) who started treatment with nevirapine (66%) or efavirenz (34%) based HAART. Median duration of follow-up was 168 (IQR: 120–192) weeks. The median CD4% increase from baseline was 7% (IQR: 5–11) and 18% (IQR: 12–23) at weeks 24 and 96, respectively. The probability of reaching target CD4% was 51% (95% confidence interval: 45%–57%) by week 96. The predictors of immune recovery at week 96 were younger age, female gender, higher baseline CD4%, and sustained virologic suppression after week 24.

Conclusion: In this cohort of children with low baseline CD4, half achieved immune recovery after 96 weeks of HAART. The predictors for immune recovery are younger children, female gender, high baseline CD4%, and long-term virologic suppression.


From the *Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; †HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand; ‡National Centre in HIV Epidemiology and Clinical Research, Sydney Australia; §South East Asia Research Collaboration with Hawaii (SEARCH) Bangkok, Thailand; and ¶Department of Pediatrics, Chiang Mai University, Chiang Mai, Thailand.

Accepted for publication November 12, 2008.

Address for correspondence: Thanyawee Puthanakit, MD, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.