Eighth International Congress on Drug Therapy in HIV Infection Glasgow, UK - 12-16 November 2006

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. P359

D Shingadia, K J Lee, D Pillay, A S Walker, G Tudor-Williams, M Sharland, A Judd, D M Gibb
CHIP Steering Committee, London, UK

PURPOSE OF THE STUDY: To examine characteristics, predictors and consequences of transient increases in viral load (VL) (blips) in children on HAART in the UK and Ireland Collaborative HIV Paediatric Study.

METHODS: Blips were defined as ≥1 VL≥50c/ml between 2 values<50c/ml, <280 days apart, during sustained viral suppression (from 2 VL<50c/ml until last VL<50c/ml before change of HAART or confirmed failure (persistent VL>50c/ml)).

SUMMARY OF RESULTS: Of 595 children initiating HAART &naïve, 347 (58%) achieved sustained VL<50c/ml. Of these, 78 (23%) experienced 108 blips with median VL 137c/ml (IQR 73-374); 17 blips were >1000c/ml (max 39,838). Blips were more common during 2nd-line therapy (28/100 child-years (CY) [95%CI 16-38]) and following a previous blip (19/100CY [12-30]) compared to during 1st-line therapy without prior blips (10/100CY [8-13]). Blipping rates decreased with age at HAART initiation (IRR=0.94 [0.89-1.00] per year older, p=0.06), but were higher in children on PI (∼75% nelfinavir) regimens (IRR=1.62 [1.10-2.39], p=0.02), and in those remaining suppressed for longer (IRR 1.21 [1.05-1.39] per extra year suppressed, p=0.009). CD4 and CD8 counts were similar pre/post blip (median difference CD4= -33 (IQR -230,304), p=0.89 and CD8=10 (-236,315), p=0.51). 43% of detectable VLs during periods of suppression were blips rather than virological failure. The rate of subsequent virological failure was not significantly different between blippers and non-blippers (adj HR=0.73 [0.45-1.19]).

CONCLUSIONS: Blips are relatively common among children on HAART, occurring more frequently in those starting HAART at younger ages, on PI (mostly NFV) or 2nd-line, and after longer suppression. They do not appear to impact CD4, CD8 or risk of subsequent virological failure; natural variation, assay effects and adherence may all play a role.

Poster Session: Paediatric Infections

2006-11-12
P359

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