CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

WEDNESDAY, FEBRUARY 25, 2015 Session P-U3 Poster Session

Poster Hall

2:30 pm– 4:00 pm Treatment Outcomes Among Children and YouthWith HIV 913 Immunodeficiency at the Start of ART in Children: A Global View Klea Panayidou 1 ; Ali Judd 3 On behalf of the IeDEA Collaboration and the COHERE Collaboration 1 University of Bern, Bern, Switzerland; 2 University of Copenhagen, Copenhagen, Denmark; 3 University College London, London, United Kingdom

Background: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) are important prognostic factors in children starting therapy and a key indicator of program performance. We describe trends in percentages of children with severe immunodeficiency at cART initiation in children from low-, middle- and high-income countries. Methods: Data from the International epidemiologic Databases to Evaluate AIDS (IeDEA) from the Caribbean, Central and South America (CCASA), Asia-Pacific, and West, Central, East and Southern Africa and from the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) were analyzed. Patients aged <16 years with known sex were eligible. Analyses were stratified by World Bank country income classification (as of 01/2013), age group (<1, 1-2, 3-4, 5-11, 12-15 years), sex and country. Missing CD4 counts and CD4%were multiply imputed. Weighted generalized additive mixed models were used to smooth the percentage starting with severe immunodeficiency over the years. Fitted/predicted percentages were aggregated using Rubin’s rules. Severe immunodeficiency was defined by WHO criteria as CD4%<25% (age <12 months), <20% (12-35), <15% (36-59) and CD4 count <200 cells/ m l or CD4%<15% in children aged >5 years. Results: A total of 43,071 patients from 31 countries were included: 37,006 children from sub-Saharan Africa (18 countries), 1,811 from Europe (4), 3,268 from Asia-Pacific (6) and 986 from CCASA (3). Trends in percentages of children starting with severe immunodeficiency from 2002, when ART was scaled up globally, varied by age and country income group (figure). In 15 countries 50-74% of children had severe immunodeficiency in 2013: Benin, Burkina Faso, Cambodia, Ghana, India, Indonesia, Malaysia, Mali, Mozambique, Senegal, United Republic of Tanzania, Thailand, Uganda, Vietnam, Zimbabwe. In 13 countries the percentage in 2013 was 25-49%: Brazil, DRC, Côte d’Ivoire, Haiti, Kenya, Lesotho, Malawi, Peru, Rwanda, South Africa, Togo, United Kingdom, Zambia. In 3 countries it was <25% in 2013: France, Netherlands, Spain.

Poster Abstracts

Conclusions: Despite progress in many low- and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority. 914 Immune Recovery at 5 Years on ART in HIV+ Children From Four African Countries Chloe A.Teasdale; Ruby Fayorsey; Zenebe Melaku; Duncan Chege; Catarina Casalini;Thresia Sebastian; Elaine J. Abrams ICAP at Columbia University, New York, NY, US Background: By 2012 more than 640,000 children were receiving antiretroviral therapy (ART) worldwide but there are few descriptions of long term treatment outcomes in children enrolled in routine service programs in sub-Saharan Africa. We examined immune recovery after 5 years on ART in children in Ethiopia, Kenya, Mozambique and Tanzania. Methods: Routinely collected patient level data were used to describe HIV-infected children 0-14 years(yrs) enrolled at ICAP-supported sites 2005-2009 with >=5yrs of follow-up. Data came from the Optimal Models study and were de-identified prior to analysis. We examined the proportion of children on ART who achieved immune recovery defined as CD4 cell count (CD4) >=500 cells/mm 3 . Relative risk regression was used to examine factors associated with immune recovery adjusting for country, year of enrollment, gender, and age, CD4, WHO stage and regimen at ART initiation. Results: 22,814 children were enrolled in care at 185 health facilities with median age of 4yrs [interquartile range(IQR):2-8]; 11,187 (49.0%) started ART, 6,961 (30.5%) were lost to follow-up, 1,034 (4.5%) died and 1,676 (7.3%) transferred before ART. 3,270 (29.2%) children who started ART and had >=5yrs of follow-up (median follow-up was 6yrs[IQR:5- 7]). At ART initiation, 11.3%were <2yrs, 29.4%were 2-4yrs, 38.5%were 5-9yrs and 20.8%were 10-14yrs of age. Median CD4 was 256 [IQR:129-503] at ART initiation and 730 [IQR 430-1065] at the last CD4 during follow-up. Immunologic recovery was observed in 67.5% of children. Children <5yrs at ART initiation were 20%more likely to achieve immune recovery (adjusted risk ratio (aRR) 1.2, 95%CI 1.1-1.3, p<0.0001) and those with CD4>=200 at ART initiation were 30%more likely to have immune recovery (aRR 1.3, 95%CI 1.2-1.4, p<0.0001). Children initiating treatment with a D4T-based ART regimen were 10%more likely to have immune recovery compared to those starting AZT-based regimens (aRR 1.1, 95%CI 1.1-1.2, p<0.0001).

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CROI 2015