16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

LONG-TERM EFFECTIVENESS OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ON THE SURVIVAL OF CHILDREN AND ADOLESCENTS INFECTED WITH HIV-1

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. WeAb0303

Patel K.¹, Hernán M.A.¹, Williams P.L.², Seeger J.D.¹, McIntosh K.³, Seage III G.R.¹, for the Pediatric AIDS Clinical Trials Group 219/219C Study Team
¹ Harvard School of Public Health, Epidemiology, Boston, United States, ² Harvard School of Public Health, Biostatistics, Boston, United States, ³ Harvard Medical School, Children's Hospital, Boston, United States

BACKGROUND: Randomized controlled trials of highly active antiretroviral therapy (HAART) in children have focused primarily on intermediate immunologic and virologic markers of HIV progression. Estimating the effectiveness of HAART on survival in this population is therefore reliant on observational studies, which are susceptible to confounding by severity (i.e., sicker patients initiating HAART earlier). We utilized marginal structural models to overcome this problem in a prospective study of HIV-positive children.

METHODS: 1326 children and adolescents perinatally infected with HIV who were in study or enrolled after January 1996 in a US-based multicenter prospective cohort study (Pediatric AIDS Clinical Trials Group 219/219C) and who were not on HAART at baseline were followed for mortality within five years. Weighted Cox regression models were used to estimate the effect of HAART on survival, using the approach of marginal structural models to account for confounding by severity.

RESULTS: Within 5 years of follow-up, 65% of participants had initiated HAART. Lower CD4% was associated with an increased probability of initiating HAART. The hazard ratio (HR) for HAART compared with non-HAART regimens using the weighted Cox model was 0.28 (95% CI: 0.12 – 0.69). HAART including a protease inhibitor was associated with a 66% reduction in mortality compared with non-HAART regimens (HR=0.34, 0.14 – 0.81).

CONCLUSIONS: The use of HAART is highly effective in reducing mortality among children and adolescents infected with HIV. Effects of HAART on survival, appropriately controlling for confounding by severity, are consistent with those observed in adult trials.

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2006-08-13
WeAb0303

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