AEGiS-15IAC: Poor virological response to HAART among infants in the collaborative HIV paediatric study (CHIPS) in the UK and Ireland.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Poor virological response to HAART among infants in the collaborative HIV paediatric study (CHIPS) in the UK and Ireland.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrB1188)

Doerholt K, Duong T, Sharland M, Tookey P, Butler K, Lyall H, Dunn D, Gibb DM
MRC Clinical Trials Unit, London, United Kingdom

BACKGROUND: CD4 and viral load (VL) are poor predictors for progression to AIDS/death in infancy. In addition to a paucity of studies evaluating early treatment in infancy, adherence difficulties and limited pharmacokinetic data complicate decisions about starting HAART in infancy.

METHODS: The CHIPS cohort has followed HIV infected children since 1996 at 18 centres in UK/Ireland. Demographic data were available from the National Study of HIV in Pregnancy and Childhood. The use of HAART and response in infants born since 1997 and diagnosed<1year of age is described.

RESULTS: 106/117 (91%) infants were born in UK/Ireland; 87 (74%) were black African; median age at diagnosis was 3.8 months(IQR 2.5-7.1); median CD4% 25%(IQR 16-37) and median VL 5.7log copies/ml. 21 (20%) were born to mothers diagnosed before delivery; of 96 infants born to previously undiagnosed women, 42 presented with AIDS. 76 (65%) infants started HAART by 12 months of age, including 11/21 (52%) followed from birth. 58 (76%) received a 3-drug regimen, 18 (24%) a 4-drug regimen. 32 (42%) of regimens included an NNRTI (mainly Nevirapine), 35 (46%) a PI (mainly Nelfinavir). Most frequently used HAART regimens were ZDV+3TC+ABC+NEV (2000-) and DDI + D4T + NFV (1997-99). Median VL reduction after 6 months was 2.4 log copies/ml, but only 48% infants achieved VL<400. Median CD4% at start of HAART was 22%(IQR 10-32) increasing to 32%(IQR 25-36) after 6 months.13 of 15 deaths occurred in infants presenting with AIDS; 6 had not started HAART and 3 died within 3 months of starting. Discussion: 65% of infants started HAART before their first birthday, including 52% of those known to be at risk of HIV from birth. HAART resulted in good immunological responses. However, high virological failure rates raises concerns about development of early resistance. In view of the paucity of trials of HAART in early infancy collaborations between existing cohorts are required for better evaluation of HAART in this age group.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, HIV, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Viral Load, HIV Infections, Anti-HIV Agents, HIV-1, Nelfinavir, Zidovudine, Stavudine, Nevirapine, Didanosine, Poverty, HIV Protease Inhibitors, Ireland, Infant, Humans, Female, Child, Pregnancy, virology

040711
TuOrB1188