AEGiS-15IAC: Opportunistic infections in the post HAART era.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Opportunistic infections in the post HAART era.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrA1018)

Ylitalo N, Nachman S, Brogly S, van Dyke R, Hughes M, Seage G
Harvard School of Public Health, Harvard University, Boston, United States

BACKGROUND: Despite the initial success of HAART on the morbidity and mortality in HIV+ children, opportunistic illnesses (OI's) continue to occur. The objective of this study was to describe the occurence of OI's in relation to time on HAART.

METHODS: 2063 HIV+ children who were on HAART and followed in the prospective 219C cohort in the US from Sep 1, 2000 to Aug 31, 2003 were evaluated. Incidence rates of OI (CDC category B and C) events for this period were calculated. Using Kaplan-Meier methods, and adjusting for CD4% and viral load, the relation between the occurence of OI's and both age at HAART initiation and duration of HAART use were estimated.

RESULTS: Among the 2063 subjects, 262 (12.7%) developed OI's during follow-up. The incidence rates (IR) of an OI category B event was 5.87 (95% CI 5.14-6.69) and OI category C event 1.66 (95% CI 1.29-2.10) per 100 person-years. The most frequently occuring OI was bacterial pneumonia, IR 3.68 (95% CI 3.11-4.32) per 100 person-years. Regardless of age at HAART initiation, and HAART duration, the proportion of subjects within different CD4% and viral load categories were relatively unchanged during follow-up. The probability of developing an OI after 33 months of follow-up increased with both age at initiating HAART and duration of HAART use. The subjects at highest risk were those who initiated HAART after age 10 and were on HAART 4+ years, having an estimated probability of any OI of 28.5% (95% CI 13.0-43.9), or infants (born after maternal antiretroviral use became common) who started HAART right after birth and were on it for several years. This finding was also observed in children with >15 CD4%.

CONCLUSIONS: OI's continue to occur in the post HAART era predominantly among older children who initiated HAART late and were treated for several years or infants who started HAART in the first year of life. Further investigation of these pneumonia events is warranted.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Opportunistic Infections, Viral Load, Acquired Immunodeficiency Syndrome, Incidence, HIV Seropositivity, Pneumonia, Child, Humans, Infant

040711
MoOrA1018