Patterns of plasma human immunodeficiency virus type 1 RNA response to highly active antiretroviral therapy in infected children

This study examined the rate of decline in plasma human immunodeficiency vi rus type 1 (HIV-1) RNA levels to <400 and <50 copies/ml in children receivi ng highly active antiretroviral therapy (HAART) consisting of efavirenz, ne lfinavir, and 1 or 2 nucleoside reverse-transcriptase inhibitors. Children receiving HAART achieved a plasma HIV-1 RNA level <400 copies/ mi, by a med ian of 4 weeks after initiation of therapy and a decline to <50 copies/ml b y 20 weeks. Baseline plasma HIV-1 RNA levels affected the likelihood of ach ieving potent and sustained virus suppression, and children whose CD4 lymph ocyte counts increased >70 cells/ muL by 20 weeks on therapy were more like ly to achieve durable virological and immunological benefit. These data pro vide time frames for virus suppression after the initiation of HAART that s hould be useful in evaluating the potential efficacy and durability of resp onse of newly instituted combination antiretroviral therapy in HIV-1-infect ed children.