AEGiS-13IAC: Rapid sequencing of paediatric antiretrovirals (ART) in south London

AEGiS-13IAC: Rapid sequencing of paediatric antiretrovirals (ART) in south London - An audit of 166 ART regimens.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Rapid sequencing of paediatric antiretrovirals (ART) in south London - An audit of 166 ART regimens.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB179)

Doerholt K, Sharland M, Ball C, Du Mont G
K. Doerholt, St George's Hospital, Paed Inf Dis Unit, Blackshaw Road, London SW17 0QT, United Kingdom, Tel.: +44 181 725 3262, Fax: +44 181 725 3262, E-mail: m.sharland@sghms.ac.uk

INTRODUCTION: - No audit data is currently available in children to demonstrate the impact of combination ART on standard outcome measures outside clinical trials. The collaborative group PHILS-NET (Paediatric HIV In London South Network)cohort database was used to audit ART use and outcome variables.

METHODS: - 110 HIV infected children followed from Jan 1996 - Sept 1999 were analysed with respect to demographic variables, ART use, viral load (VL), CD4 count, and morbidity/mortality data.

RESULTS: - Mean age at presentation 2.7 years, and at analysis (Sept 1999) 6.3 years. 90 children (81%)are now on combination ART, and have received 166 ART regimens so far. Following failure of first line ART regimens, children have sequenced onto 2nd/3rd/4th line regimens. The mean duration of completed regimens was 1st line (n = 54)- 325 days; 2nd line (n = 23) - 292 days, 3rd line (n = 9)- 281 days. The mean VL reduction (start-end) was 1st line 1.53log, and 2nd line 0.85 log, and 3rd line 0.83 log₁₀. The mean increase in absolute CD4 count was 1st line 265, 2nd line 131, 3rd line 200 cells/mm³. Only 6 children on ART progressed in CDC clinical staging. Regimens were mostly changed due to virological (60%) and/or adherence (25%) failure.

CONCLUSION: - Most children on combination ART are staying clinically very well. However they are rapidly sequencing through ART regimens. The duration and VL/CD4 responses decrease with each change in therapy. It is unclear that the rate of new drug development will keep up with current drug utilisation. A more cautious approach to ART sequencing based solely on virological failure may be more appropriate in children.

Keywords: AEGIS, Viral Load, CD4 Lymphocyte Count, HIV Infections, London, Child
000709
MoOrB179