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Randomized Controlled Trial
. 2016 Sep 24;30(15):2303-13.
doi: 10.1097/QAD.0000000000001158.

Treatment interruption after 2-year antiretroviral treatment initiated during acute/early HIV in infancy

Dalton Wamalwa  1 , Sarah Benki-Nugent, Agnes Langat, Kenneth Tapia, Evelyn Ngugi, Helen Moraa, Elizabeth Maleche-Obimbo, Vincent Otieno, Irene Inwani, Barbra A Richardson, Bhavna Chohan, Julie Overbaugh, Grace C John-Stewart
Affiliations
Randomized Controlled Trial

Treatment interruption after 2-year antiretroviral treatment initiated during acute/early HIV in infancy

Dalton Wamalwa et al. AIDS. .

Abstract

Objective: Treatment interruption has been well tolerated and durable in some pediatric studies but none have compared treatment interruption with continued antiretroviral treatment (ART) following ART initiation in early HIV. The objective of this study was to compare outcomes in treatment interruption versus continued ART among early-treated infants.

Design: Randomized trial (OPH-03; NCT00428116).

Methods: The trial included HIV-infected infants who initiated ART at less than 13 months of age, received ART for 24 months, and, if eligible (CD4% >25%, normal growth), were randomized to treatment interruption versus continued ART. Children in the treatment interruption group restarted ART if they met WHO ART-eligibility criteria. During 18-months postrandomization, primary outcomes were incidence of serious adverse events and growth. CD4%, viral load, morbidity, and growth were compared.

Results: Of 140 infants enrolled, 121 started ART, of whom 75 completed at least 24 months ART and 42 were randomized (21 per arm). ART was initiated at median age 5 months and randomization at 30 months. Among 21 treatment interruption children, 14 met ART restart criteria within 3 months. Randomization was discontinued by Data and Safety Monitoring Board due to low treatment interruption durability. At 18 months postrandomization, growth and serious adverse events were comparable between arms; hypercholesteremia incidence was higher in the continued arm (P = 0.03). CD4% and viral load did not differ between arms [CD4% 35% and median viral load undetectable (<150 copies/ml) in both arms, P = 0.9 for each comparison]. No infants had post-treatment viral control.

Conclusion: Short treatment interruption did not compromise 18-month CD4%, viral control, growth, or morbidity compared with continued ART among infants who started ART in early HIV infection.

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Figures

Figure 1
Figure 1. CONSORT Diagram of Trial
1. 4 did not meet ART restart criteria but were started due to caregiver’s preference (2) or study team advice (2)
Figure 2
Figure 2. CD4, Viral Load, and Growth Changes by Randomization Arm
A. CD4% by Randomization Arm Note. Individual observations for Continued (circles) and Interrupted (squares) are plotted. Lowess curves of pre-randomization data (dashed lines) and of post-randomization (solid lines) for Continued (navy) and Interrupted (maroon) are included. B. Viral Loads for Randomized Subjects by Arm C. WAZ since Randomization, by Arm D. HAZ since Randomization, by Arm E. WHZ since Randomization, by Arm
Figure 2
Figure 2. CD4, Viral Load, and Growth Changes by Randomization Arm
A. CD4% by Randomization Arm Note. Individual observations for Continued (circles) and Interrupted (squares) are plotted. Lowess curves of pre-randomization data (dashed lines) and of post-randomization (solid lines) for Continued (navy) and Interrupted (maroon) are included. B. Viral Loads for Randomized Subjects by Arm C. WAZ since Randomization, by Arm D. HAZ since Randomization, by Arm E. WHZ since Randomization, by Arm
Figure 2
Figure 2. CD4, Viral Load, and Growth Changes by Randomization Arm
A. CD4% by Randomization Arm Note. Individual observations for Continued (circles) and Interrupted (squares) are plotted. Lowess curves of pre-randomization data (dashed lines) and of post-randomization (solid lines) for Continued (navy) and Interrupted (maroon) are included. B. Viral Loads for Randomized Subjects by Arm C. WAZ since Randomization, by Arm D. HAZ since Randomization, by Arm E. WHZ since Randomization, by Arm
Figure 2
Figure 2. CD4, Viral Load, and Growth Changes by Randomization Arm
A. CD4% by Randomization Arm Note. Individual observations for Continued (circles) and Interrupted (squares) are plotted. Lowess curves of pre-randomization data (dashed lines) and of post-randomization (solid lines) for Continued (navy) and Interrupted (maroon) are included. B. Viral Loads for Randomized Subjects by Arm C. WAZ since Randomization, by Arm D. HAZ since Randomization, by Arm E. WHZ since Randomization, by Arm
Figure 2
Figure 2. CD4, Viral Load, and Growth Changes by Randomization Arm
A. CD4% by Randomization Arm Note. Individual observations for Continued (circles) and Interrupted (squares) are plotted. Lowess curves of pre-randomization data (dashed lines) and of post-randomization (solid lines) for Continued (navy) and Interrupted (maroon) are included. B. Viral Loads for Randomized Subjects by Arm C. WAZ since Randomization, by Arm D. HAZ since Randomization, by Arm E. WHZ since Randomization, by Arm
Figure 3
Figure 3. CD4 and viral load changes among infants before, during and after treatment interruption
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