Background:  HAART interruptions in acute HIV-infection in adults has been reported to be effective. Vertical transmission is a type of acute HIV infection. On the other hand, in some children who began HAART because of virological criteria, current guidelines would not support such a therapeutic approach. Finally, some patients with multidrug-resistant HIV who suffer from ART side-effects may also benefit drug holidays. Our objective was to describe the clinical, virological, and immunological evolution of HIV-infected children who underwent HI because of drug toxicity, treatment uselessness and/or parents decision.

Methods:  We studied 20 patients on HAART:  9 naïve children (group A, 3 with acute infection who initiated treatment before 8 weeks; group B, 6 who started HAART at >2 years) and 11 patients exposed previously to other antiretroviral combinations (group C).

Results:  While all of them were classified in CDC immunological category 1 and asymptomatic when HAART interruption was started, only naïve patients showed undetectable HIV viral load at that time. Patients in group A have remained asymptomatic along HAART interruptions and although we have observed a decrease in CD4 lymphocyte count, it has remained in the normal range in all cases. All the children in group B have remained clinically stable and high CD8 lymphocytes counts have been observed overtime, while 4 out of 6 have maintained normal CD4 counts. All the patients in group C have remained free from AIDS-defining conditions during HI but HAART was reinitiated in 2 of them because of CD4 count decreases. In all cases where HAART toxicity occurred, a clinical improvement in those conditions after HI has been observed.

Conclusions:  HAART interruption in selected cases may represent a useful therapeutic strategy for HIV infection to prevent drug toxicity and should also be considered in the pediatric age.

Keywords: HAART INTERRUPTION; PEDIATRICS; CELLULAR IMMUNITY