[MoOrB1132] Highly active antiretroviral therapy usage patterns among HIV-positive children, pediatric spectrum of disease cohort, USA, 1998-2000

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Highly active antiretroviral therapy usage patterns among HIV-positive children, pediatric spectrum of disease cohort, USA, 1998-2000

[AUTHOR(S):] M. McConnell¹, T. Sukalac, K. Dominguez², H. Hsu³, J.C. Orengo⁴, T. Rakusan⁵, V. Peters⁶, S. Melville⁷, T. Frederick⁸, P.S.D. Pediatric Spectrum of HIV Disease Consortium⁹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1132

BACKGROUND: It is critical to monitor patterns of antiretroviral therapy (ART) usage in the era of highly active antiretroviral therapy (HAART). Current guidelines for initial ART in children recommend at least three drugs.

METHODS: The Pediatric Spectrum of Disease (PSD) is an ongoing longitudinal chart review of HIV-positive children at six U.S. sites. We describe trends and changes in ART regimens from April 1998 through December 2000 for HIV-positive children >1 year of age, with a median age of 8 years.

RESULTS: Of 1,541 children followed in 2000, 89% were perinatally infected and 98% of these were receiving ART in 2000. Of those on therapy, 76% had received HAART in 1998 and 88% in 2000. The median number of drugs per regimen was two in 1998 and three in 2000. The percentage of children on each ART drug class in 2000 was 96% (nucleoside analogue reverse transcriptase inhibitor), 70% (protease inhibitor), 38% (non-nucleoside reverse transcriptase inhibitor). The drugs most commonly used in 2000 were stavudine (67%), lamivudine (67%) and nelfinavir (46%); drugs increasingly used from 1998 through 2000 (p<0.001) were abacavir (3% to 12%), efavirenz (3% to 17%), and amprenavir (at least 0.4% to 9.3%). The median number of yearly changes in regimens was less than one, and the median number of drugs changed at a time was at least two in 1998 and three in 2000. Primary reasons for changes were drug failure (30%), nonadherence (14%), and adverse reactions (14%).

CONCLUSIONS: Since 1998, HAART usage has increased and most children are now receiving at least three drugs. However, drug failures and changes in drug regimens are not uncommon. This underscores the importance of monitoring ART usage patterns and the long-term success and tolerance of HAART in the HIV-positive pediatric population.

Presenting author: Michelle McConnell

1EIS, Division of Applied Public Health Training, Division of HIV/AIDS, CDC, 1600 Clifton Road, MS-E45, Atlanta, Georgia, 30333, United States.

2Division of HIV/AIDS, CDC, Atlanta, United States.

3State Laboratories Institute, Jamaica Plain, United States.

4Departamento de Salud, San Juan, United States.

5Childrens National Medical Center, Washington, United States.

6New York City Department of Health, New York, United States.

7Texas Department of Health, Austin, United States.

8Los Angeles County Dept. of Health, Los Angeles, United States.

9CDC, Atlanta, United States.

020708
MoOrB1132