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14th International AIDS ConferenceBarcelona, Spain — July 7-12, 2002 |
Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1131
BACKGROUND: Delaying initiation of ART is an appealing strategy in children who face prolonged courses of therapy exposing them to toxicity and compliance problems. In resource-poor settings, it is also attractive to limit use of antiretroviral therapy among children until it becomes necessary. PENTA guidelines suggest starting ART when CD4%<20.
METHODS: A cohort of 51 HIV-infected children has been followed for 3 years at an outpatient service at Chris Hani Baragwanath Hospital, Soweto, South Africa. Children selected were age-matched according to clinically-defined mild (n=26) or severe (n=25) disease (median age 4 years). The severe group included children with late category B and C disease. Children have been followed clinically and have annual tests for virological and immunological deterioration. They are followed until enrolled into clinical trials or started on ART.
RESULTS: Over the 3 years, 16 (31%) children died, 14 with severe and 2 with mild disease at enrollment, 5 (10%) were lost to follow-up and 6 (12%) started ART. Survival to 3 years by Kaplan-Meier methods was significantly associated with higher CD4%, lower HIV RNA copy number and higher weight-for-age at enrollment. Clinical status at enrollment predicted 88% of the deaths, CD4%<15 73%, RNA copies >105 75%, and low weight-for-age 63%. Of children with CD4%>20 at enrollment, 20% died or dropped their CD4% below 15 within 3 years after enrollment.
CONCLUSIONS: In this cohort, clinical, immunological and virological parameters at enrollment were strongly predictive of disease progression and can be used to identify children in urgent need of ART. One in five children with reasonable immune function will deteriorate within 3 years. Regular monitoring is essential to detect those in need of urgent treatment.
Presenting author: Tammy Meyers
1Paediatrics Department, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Paediatrics Dept, Chris Hani Baragwanath Hospital, PO Bertsham, 2013, South Africa.
2Mailman School of Pubic Health, Columbia University, New York, United States.
3National Institute for Communicable Diseases, Johannesburg, South Africa.
4Paediatrics Department, Chris Hani Baragwanath Hospitalan University of the Witwatersrand, Johannesburg, South Africa.
5Department of Molecular Medicine and Haematology, South African Institute for Medical Research, Johannesburg, South Africa.
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MoOrB1131
Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.
