Early versus deferred antiretroviral multidrug therapy in infants infected with HIV type 1

Background. The clinical impact of early antiretroviral multidrug therapy on the risk of early-onset severe human immunodeficiency virus (HIV) disease has not been evaluated on a large scale. Methods. We evaluated the risk of early-onset events associated with acquired immunodeficiency syndrome ( AIDS), particularly the risk of encephalopathy, among infants in the French Perinatal Cohort, according to whether antiretroviral multidrug therapy was initiated before or after the age of 6 months. Results. Of 83 HIV-infected infants born in 1996 ( when HAART became available) or later, 40 received early treatment on or before the age of 6 months, and 43 received deferred multidrug therapy after the age of 6 months. In the group that received early multidrug therapy, no child developed an opportunistic infection or an encephalopathy during the first 24 months of life. In the deferred multidrug therapy group, 6 infants presented with a total of 7 AIDS-associated events (), 3 of which were encephalopathies (). The small number of Pp. 01 Pp. 08 events prevented the identification of clinical and biological markers that accurately predict progression of early-onset severe HIV disease. Conclusion. In this observational study, infants who received multidrug therapy before 6 months of age did not have the early-onset severe form of childhood HIV disease. Further studies are needed to find accurate early markers of disease progression in this age group.