CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

estimating equations). Additional analyses were performed using marginal structural models (MSM) to account for treatment switching and censoring. Models were adjusted for demographics and HIV disease status at entry. Results: 229 participants were randomized to NVP and 222 to LPV/r based ART. As of January 2014, 75%were still in follow-up (median follow-up 4.6 years [IQR: 3.7-5.7]). From their original randomization, 48%were still on NVP while 81%were still on LPV/r. Participants in the NVP arm had significantly shorter time to VF (adjusted hazard ratio [aHR]: 1.91, 95%CI: 1.37-2.65) but not death (aHR: 1.64, 95%CI: 0.72-3.75). Mean CD4% and weight z-scores were higher in the NVP arm at 1 year, by 1.5% and 0.23 respectively (p<0.05), while height z-scores were not significantly higher by 0.15 (p=0.10). By the second year of follow-up, differences were no longer statistically significant. Similar trends were observed in MSMmodels for all outcomes. Conclusions: Long-term virologic suppression was superior in children on LPV/r-based ART compared to NVP-based regimens. Early modest gains in CD4% and growth associated with NVP were no longer statistically significant beyond 1 year after ART initiation. These findings further support the current WHO recommendation for LPV/r-based ART as first line therapy for HIV-infected children aged < 3 years. 37 Structural Cardiovascular Changes Are Reversible in HIV-Infected Children in Zambia and Uganda. Julia M. Kenny 1 ; Adrian Cook 1 ; Grace Mirembe 2 ; Dorica Masaku 3 ; PriscillaWavamunno 2 ; Florence Odongo 2 ; Alicja Rapala 1 ; John Deanfield 1 ; Diana M. Gibb 1 ; Nigel J. Klein 1 1 University College London, London, United Kingdom; 2 Joint Clinical Research Centre, Kampala, Uganda; 3 University Teaching Hospital, Lusaka, Zambia Background: Carotid intimal medial thickness (IMT) and pulse wave velocity (PWV), as measures of cardiovascular structure/function, are impaired in HIV-infected children in high-income countries. Few longitudinal data are available: none come from Africa where 90% HIV-infected children live. Methods: ART-naïve and ART-experienced (on d4T+3TC+NNRTI for >2years, virologically suppressed at enrolment) HIV-infected children had IMT and PWV measured at baseline, 48 and 96 weeks within the CHAPAS-3 trial which evaluated d4T vs ZDV vs ABC-based first-line ART in Uganda/Zambia. Age-matched HIV-uninfected controls had a single assessment. Baseline differences between ART-naïve/experienced children vs controls, and longitudinal changes in HIV-infected children were compared using two-sample and paired t-tests respectively. Results: In 208 ART-naïve children with median age 2.9y (IQR 1.7–4.4), median CD4% 18% (11-23) and 209 HIV-uninfected controls median age 3.0y (2.1–4.1), mean(sd) cIMT was 0.46(0.04) v 0.44(0.04)mm respectively (p=0.0001); PWV was 5.85(0.8) vs 5.67(0.74)m/sec respectively (p=0.04). Among 74 ART-experienced children on ART for mean 3.7y with median age 6.9y (5.9–8.50, median CD4% 33% (27-39) and 75 uninfected controls with median age 6.7y (5.6-8.6), mean(sd) cIMT was 0.46(0.05) vs 0.45(0.04)mm respectively (p=0.09); PWV was 5.63(0.61) vs 5.69(0.69)m/s respectively (p=0.57). In ART naïve children IMT and PWV significantly decreased from baseline (ART initiation) to week 96 mean(sd) cIMT -0.02(0.04)mm (p=0.0001), PWV -0.38(0.83)m/s (p<0.0001). In contrast whereas cIMT had significantly reduced by mean -0.2(0.06)mm (p=0.01) at week 96 in the ART experienced group PWV increased by 0.35(0.63)m/s (p<0.0001). There was no evidence that the changes differed by randomisation ART in either group (p=0.6).

Oral Abstracts

Graph to show changes in IMT and PWV over 96 weeks in ART naive and ART experienced children with baseline data from age-matached HIV uninfected controls. Conclusions: In this large study of arterial structural and function in HIV-infected children in Africa, ART-naïve HIV-infected children had significantly poorer IMT and PWV compared to age-matched controls but significant improvement seen after 96 weeks of ART. After a mean 3.7 years on ART, HIV-infected children had cIMT and PWV comparable to uninfected age-matched controls. IMT continued to improve after a further 96 weeks on ART. ART can reverse some of the structural/functional changes caused by HIV, strengthening the argument for early diagnosis and treatment of HIV-infected infants and children.

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CROI 2015