Epidemiology alumnus studies ways to optimize pediatric antiretroviral therapy

Oct. 9, 2014

Dr. Dwight Yin

A new study helps clinicians weigh immunologic benefits against viral failure risks when timing the administration of antiretroviral therapy for children who are HIV-positive.

Dwight E. Yin, MD, MPH, alumnus of the UNC Gillings School of Global Public Health’s epidemiology department and assistant professor of pediatrics at the University of Missouri at Kansas City, is lead author of the study, “Using CD4 Percentage and Age to Optimize Pediatric Antiretroviral Therapy Initiation,” published online Sept. 29 in the journal Pediatrics.

Yin also is a physician and director of HIV services in the Department of Pediatrics’ Division of Infectious Diseases at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Children with HIV face many challenges, from medication side effects and social stigma to how well their immune systems will protect them. Such challenges complicate decisions on when to start HIV treatment. To help decide the best time to start treatment, doctors and policy makers need to know more than just facts about one strategy being better than another. They need to know how much better.

Yin and his team analyzed data from 162 children from 13 countries in Europe, North America and South America to assess how well their CD4 percentages (a measure of the immune system) improved on HIV treatment, based on their CD4 percentages and ages when starting treatment.

Children who started treatment earlier — namely, at younger ages and healthier CD4 percentages — had much better immune recovery. However, not everyone kept all the immune benefits four years later.

“This problem was worst in the youngest children and in adolescents,” Yin said. “Our results are designed to provide numbers for weighing benefits of better immune recovery against risks of failing treatment (or other risks) when deciding the best time to start HIV treatment in children.”