Background:  HAART has significantly reduced mortality and morbidity in HIV-infected patients; however, there has been increasing concern regarding the long-term use of ART. Treatment interruption has become 1 of the options in HIV-infected adults; however, little information is available on HIV-1-infected children and adolescents who interrupt treatment.

Methods:  Virologic and immunologic data were analyzed on 16 children and adolescents who underwent unstructured treatment interruption of HAART in the Child-Adolescent HIV program at the University of California, San Diego. All had taken HAART for at least 6 months before treatment interruption, and they stopped HAART for at least 6 months.

Results:  Median age of patients was 14.4 years (range 9.0 to 22.4); 13 (81%) were female. The reasons for the treatment interruption were:  poor compliance (n = 10, 63%), determined by themselves (n = 3, 19%), lipodystrophy (n = 1, 6%), pregnancy (n = 1, 6%), and drug-induced hepatitis (n = 1, 6%). Ten patients (63%) received protease inhibitors (PI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) with 1 or 2 nucleoside reverse transcriptase inhibitors (NRTI), whereas 6 patients (37%) received PI with 1 or 2 NRTI. Five patients (31%) had RNA < 400 copies/mL before treatment interruption. Over the first 6 months, median CD4% decrease was 4% (IQR 2 to 8%). Median plasma HIV-1 RNA increased from 3.5 log₁₀ copies/mL (IQR 2.4 to 4.7log₁₀ copies/mL) to 4.3 log₁₀ copies/mL (IQR 3.9 to 4.7 log₁₀ copies/mL). At 12 months, median CD4% decrease was 3% (IQR 1 to 7%), and RNA was 4.4 log₁₀ copies/mL (IQR 3.4 to 4.6 log₁₀ copies/mL), which were unchanged compared to those at 6 months (p = 0.49 and p = 0.88). During the median follow-up of 19 months (range 6 to 48 months), 2 patients (13%) resumed ART because of the significant decline of CD4% (8% and 6%) at 6 and 17 months after treatment interruption. Two patients experienced AIDS-defined illnesses at 12 and 18 months after treatment interruption:  a 10-year-old male with miliary tuberculosis with CD4% of 26%, and a 17-year-old female with disseminated MAC infection with CD4% of 2%. These 2 patients had a persistent detectable RNA >10⁵ copies/mL before and after treatment interruption, whereas the rest of 14 patients remained RNA < 10⁴ copies/mL during the first 12-month period. Nadir CD4% before treatment interruption did not predict CD4% decrease at 6 months (p = 0.98) and 12 months (p = 0.73).

Conclusions:  Unstructured treatment interruption was a useful option in HIV-1-infected children and adolescents; however, close follow-up is necessary in selected patients, especially with higher plasma HIV-1 RNA before and after treatment interruption.

Keywords: treatment interruption; children; adolescents