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A mechanistic model for long-term immunological outcomes in South African HIV-infected children and adults receiving ART.
Ujeneza, Eva Liliane; Ndifon, Wilfred; Sawry, Shobna; Fatti, Geoffrey; Riou, Julien; Davies, Mary-Ann; Nieuwoudt, Martin.
Afiliación
  • Ujeneza EL; Department of Science and Technology and National Research Foundation, South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
  • Ndifon W; African Institute for Mathematical Sciences (AIMS), Next Einstein Initiative, Kigali, Rwanda.
  • Sawry S; African Institute for Mathematical Sciences (AIMS), Next Einstein Initiative, Kigali, Rwanda.
  • Fatti G; Harriet Shezi Children's Clinic, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Riou J; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.
  • Davies MA; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
  • Nieuwoudt M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Elife ; 102021 01 14.
Article en En | MEDLINE | ID: mdl-33443013
The human immunodeficiency virus (HIV) remains an ongoing global pandemic. There is currently no cure for HIV, but antiretroviral therapies can keep the virus in check and allow individuals with HIV to live longer, healthier lives. These drugs work in two ways. They block the ability of the virus to multiply and they allow numbers of an important type of infection-fighting cell called CD4+ T cells to rebound. As more patients with HIV survive and transition from one life stage to the next, it is critical to understand how long-term antiretroviral therapies will affect normal age-related changes in their immune systems. The health of an immune system can be evaluated by looking at the number of CD4+ T cells an individual has, though this will vary by age and location. Clinicians use the same metrics to assess the immune health of individuals with HIV, however, as they age, it becomes a challenge to identify if a patient's immune system recovers normally or insufficiently. Thus, learning more about age-related differences in CD4+ T cells in people living with HIV may help improve their care. Using data from 1,616 children and 14,542 adults from South Africa, Ujeneza et al. created a simple mathematical model that can compare the immune system of person with HIV with the immune system of a similarly aged healthy individual. The model shows that among individuals with HIV receiving antiretroviral therapies, children have CD4+ T-cell numbers that are closest to the numbers seen in healthy individuals of the same age. This suggests that children may be more able to recover immune system function than adults after beginning treatment. Children also start antiretroviral therapies before their immune system has been severely damaged, while adults tend to start treatment much later when they have fewer CD4+ T cells left. Ujeneza et al. show that the fewer CD4+ T cells a person has when they start treatment, the faster the number of these cells grows after starting treatment. This suggests that the more damaged the immune system is, the harder it works to recover. This reinforces the need to identify people infected with HIV as soon as possible through testing and to begin treatment promptly. The new model may help clinicians and policy makers develop screening and treatment protocols tailored to the specific needs of children and adults living with HIV.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Fármacos Anti-VIH Tipo de estudio: Guideline Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Middle aged País/Región como asunto: Africa Idioma: En Revista: Elife Año: 2021 Tipo del documento: Article País de afiliación: Sudáfrica Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Fármacos Anti-VIH Tipo de estudio: Guideline Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Middle aged País/Región como asunto: Africa Idioma: En Revista: Elife Año: 2021 Tipo del documento: Article País de afiliación: Sudáfrica Pais de publicación: Reino Unido