Beschreibung:
<jats:sec><jats:title>Objectives</jats:title><jats:p>In adults with horizontally acquired <jats:styled-content style="fixed-case">HIV</jats:styled-content> infection, an inverted <jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 ratio is associated with persistent immune activation, size of <jats:styled-content style="fixed-case">HIV</jats:styled-content> reservoir and predicts an increased risk of non‐<jats:styled-content style="fixed-case">AIDS</jats:styled-content>‐defining adverse events. Normalization of this ratio with antiretroviral therapy (<jats:styled-content style="fixed-case">ART</jats:styled-content>) is suboptimal in adults, despite viral suppression, and is less well described in paediatric populations. We investigated rates of <jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 ratio recovery in children with perinatally acquired <jats:styled-content style="fixed-case">HIV</jats:styled-content> infection (Pa<jats:styled-content style="fixed-case">HIV</jats:styled-content>) on <jats:styled-content style="fixed-case">ART</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cross‐sectional, retrospective analysis of routine clinical data in children with Pa<jats:styled-content style="fixed-case">HIV</jats:styled-content> (5–18 years old) attending a single <jats:styled-content style="fixed-case">UK</jats:styled-content> centre was carried out.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 normalization was seen in 62% of children on suppressive <jats:styled-content style="fixed-case">ART</jats:styled-content>. A negative correlation was found between current <jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 ratio and age at start of <jats:styled-content style="fixed-case">ART</jats:styled-content>. Positive correlations were found between current <jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 ratio and total time with suppressed <jats:styled-content style="fixed-case">HIV</jats:styled-content> viral load and nadir <jats:styled-content style="fixed-case">CD</jats:styled-content>4 counts. Multiple linear regression analysis showed that age at start of <jats:styled-content style="fixed-case">ART</jats:styled-content> was significantly associated with current <jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 ratio (standardized β = −0.680; <jats:italic>P</jats:italic> < 0.001). Patient sex, ethnicity and antiretroviral regimen did not affect ratio recovery.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>We found higher rates of <jats:styled-content style="fixed-case">CD</jats:styled-content>4:<jats:styled-content style="fixed-case">CD</jats:styled-content>8 ratio normalization compared with previous adult studies. Children who started <jats:styled-content style="fixed-case">ART</jats:styled-content> at a younger age were more likely to recover a normal ratio. The current policy of universal treatment for all <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐positive adults and children will enhance immunological normalization.</jats:p></jats:sec>