Editor's Note: From July 22-26, 2024, the 25th International AIDS Conference took place in Munich, Germany, gathering 15,000 professionals and advocates from around the world to discuss the latest advancements and future challenges in AIDS prevention and treatment. At the conference, Dr. Hanxi Zhang from Dr. Fujie Zhang’s team at Beijing Ditan Hospital presented a multicenter, prospective, longitudinal cohort study conducted in China, which garnered widespread attention. Led by Beijing Ditan Hospital, Capital Medical University, this study aimed to evaluate the impact of antiretroviral therapy (ART) on mortality and virologic response in children and adolescents with HIV. The findings provided valuable insights into the long-term efficacy of ART in Chinese children living with HIV, indicating significant achievements of the ART program in this demographic. We invited Dr. Fujie Zhang to offer an in-depth analysis of the study's findings.Overview of the Study
Since 2005, China has implemented a national antiretroviral therapy program for children with HIV in the six provinces with the highest infection rates, expanding to 28 provinces by 2010. Given the limited availability of new ART drugs for children in developing countries, this study focused on the long-term effects of ART on pediatric HIV patients in resource-limited settings.
Research Methodology
The research team recruited participants between January 2008 and July 2021 from six representative regions in China. All participants were HIV-positive and under 18 years old, including both ART-naive and ART-experienced individuals. Survival analysis and Cox regression models were used to conduct an in-depth analysis of the participants’ survival rates and virologic failure (VF) rates.
Key Findings
A total of 592 ART-naive and 113 ART-experienced participants were included in the study. For ART-naive children, the median follow-up duration was 6.22 years (range: 2.07-8.99 years), with the longest follow-up extending to 13.43 years. During the study period, the mortality rate was 0.721 per 100 person-years, with an overall mortality rate of 4.39%. The incidence of virologic failure (VF) was 4.83 per 100 person-years, with 173 children experiencing VF. Cox regression analysis indicated that a low CD4+ T cell count at baseline and being diagnosed with HIV after the age of 5 were potential risk factors for mortality.
Notably, children with prior ART experience who were treated with lopinavir/ritonavir (LPV/r) had a higher incidence of VF compared to ART-naive children (4.98 vs. 4.05). Kaplan-Meier curves further confirmed that ART-experienced children faced a higher risk of VF (P<0.05).
Researcher’s Insights
This study not only validated the effectiveness of China’s ART program for children and adolescents with HIV but also provided valuable insights for resource-limited countries. Through long-term follow-up and data analysis, the research team found that even with limited ART options, children and adolescents with HIV could achieve favorable treatment outcomes. This finding holds significant implications for global HIV prevention and treatment efforts.
As scientific advancements continue and global health resources increase, there is hope for more effective treatment options for children and adolescents with HIV in the future. Enhancing health education, improving treatment adherence, and regularly monitoring viral load are also crucial measures that can improve treatment outcomes and further reduce mortality and virologic failure rates. The publication of this study’s results has not only renewed confidence in HIV prevention and treatment efforts in China and globally but also provided important references for future research in this field.
