Treatment-mediated changes in human immunodeficiency virus (HIV) type 1 RNA and CD4 cell counts as predictors of weight growth failure, cognitive decline, and survival in HIV-infected children

This meta-analysis of 5 large studies of the Pediatric AIDS Clinical Trials Group was undertaken to evaluate the predictive value of antiretroviral tr eatment-mediated changes in 3 markers of human immunodeficiency virus (HIV) type 1 disease progression-HIV-1 RNA level, CD4 cell count, and CD4 percen tage-for weight growth failure, cognitive decline, and survival in HIV-infe cted children. Proportional hazards models were used to assess the prognost ic value of the markers at baseline and after 24 weeks of treatment, with d ata from 1089 children. Among children receiving nucleoside with or without nonnucleoside reverse-transcriptase inhibitors, higher immunologic and low er virologic markers at baseline and after 24 weeks were significant indepe ndent predictors of survival, whereas virologic markers were significant pr edictors of weight growth and cognitive failure in children >1 year old. Th e finding of differential age effects on pediatric-specific clinical outcom es emphasizes the need for continued investigation of treatment effects in children.