Earlier treatment of perinatal HIV associated with decreased HIV progression, bette...( rcent [37/134] treated children); none ...),Health

rcent [37/134] treated children); none of 23 infants who received triple ART progressed to category C. However, even without triple ART, very early mono/dual ART (by age 2 months vs. 3-4 months) was associated with delayed and decreased progression to category C. Of 33 children born between January 1, 1996, and December 31, 2001, only 7 (21 percent) progressed to category C (compared with 1988-1995), 6 of 7 of whom received no therapy. More recent year of birth and more advanced therapy were associated with improved survival.

"There are few data to guide time to initiation and selection of therapy among young children with perinatal HIV infection. Our novel finding of improved outcomes even with mono/dual ART begun by age 2 months vs. 3 to 4 months, though limited by the small sample size, suggests the importance of very early diagnosis and treatment and is consistent with small clinical trials demonstrating a short-term protective effect of early vs. delayed ART among perinatally infected infants. Initiating ART within the first 2 months offers the potential to begin therapy during or near the time of primary infection," the authors write.

(JAMA. 2005;293:2221-2231. Available post-embargo at JAMA.com)

Editor's Note: This study is supported by funding from the Office of AIDS, California Department of Health Services.

Editorial: Balancing the Upside and Downside of Antiretroviral Therapy in Children

In an accompanying editorial, Ram Yogev, M.D., of Children's Memorial Hospital, Chicago, comments on the HIV studies in this week's JAMA.

"While it is possible to celebrate the tremendous change in the outcomes of HIV-infected children treated with HAART, it is even more important to continue to prioritize research for the survivors who are now living with a chronic disease. The notion that the problem of HIV in children has been resolved is false--indeed, 15,000 to 20,000 perinata
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Contact: Krista Conger
650-725-5371
JAMA and Archives Journals
10-May-2005

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