CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Deaths are uncommon among HIV-infected youth in the cART era, but infectious and non-infectious fatalities continue to occur, and most are HIV related. Deaths are more common among older youth, those not on cART, those with persistently lower CD4 counts, and those with higher HIV viral loads. 918 Transition to Adult Units: Situation and Evolution of Vertically HIV Infected Youths in Spain Talía Sainz 1 ; Carolina Fernández McPhee 2 ; Santiago Jimenez de Ory 1 ; Maria Isabel Gonzalez-Tome 3 ; Rafael Rubio 3 ; Jose I Bernardino 4 ; Santiago Moreno 2 ; Jose Antonio Iribarren 5 ; Belen Alejos 6 ; Marisa Navarro 7 On behalf of the Spanish Cohort of AIDS Research (CORIS) and the Pediatric Spanish Cohort of HIV-infected Children (CoRISpe) 1 Hospital Universitario Gregorio Marañón, Madrid, Spain; 2 Hospital Universitario Ramon y Cajal, Madrid, Spain; 3 12 de Octubre Hospital, Madrid, Spain; 4 La Paz University Hospital, Madrid, Spain; 5 Hospital de Donostia, San Sebastian, Spain; 6 Centro Nacional de Epidemiología, ISCIII, Madrid, Spain; 7 Hospital Gregorio Marañon, Madrid, Spain Background: Due to the success of ART, many vertically HIV-infected youths (VHY) are being transferred to adult units. Our objective was to evaluate the transition process within the Spanish Cohort of vertically HIV infected children (CoRISpe), and to address the clinical situation of VHY in comparison to their horizontally HIV-infected peers (HHY) Methods: Cross-sectional analysis including patients from 16 Hospitals, transferred to adult units between 1997 and 2012. Variables were analyzed before and one year after transition, and during follow-up (until December 2013). The cohort was compared to a cohort of HHY youths, on ART for at least one year. Results: A total of 182 VHY were transferred during the study period, 58.2% female. Median age at transition was 17.9 years [17-19]. Patients transferred between 2009-2012 showed better immunological situation compared to their peers transferred before; CD4 757 cells/mm 3 [559-932] vs 525[333-790], p<0.01, on viral suppression 62% vs 30.9%, p<0.01. Longitudinal data were available for 147 patients (4 died after transition, 6 had changed to non-participating hospitals, and 18 never showed up at adult units and are lost to follow up). From 81 virologically suppressed patients, 86.4%maintained suppression after transition, whereas in 13.6% HIV RNA became detectable. A 69.9% of patients transferred with CV>50cop/mL, achieved viral suppression after transition. No association was found between evolution and gender or age at transition, and none of the studied factors was associated with loss of viral suppression. Compared to the 46 HHI (61% heterosexual, 35%MSM), VHY were younger (24 ± 3.7 vs 26.5 ± 3.1, p<0.01) and 58% vs 57%were female (p=ns). Despite the fact that 27% vs 6.5%were on CDC stage C (p<0.01) and had lower CD4 nadir (202[78-364] vs 286[170-370] , p=0.17), their CD4 T-cell count was higher (744[IQR 505-990] vs 542[391-662], p<0.01, %CD4 33[24-39] vs 27[22-34] p<0.01 and CV<50 cop/mL : 80% vs 73%, p=0.41. On NNRTI: 27% vs 50% (p=0.04) and 74% vs 83% (p=0.41) were on a once daily regimen. Conclusions: Compared to previous years, the immunological situation of VHY transferred today is much better, and remains stable or improves after transition in 75% of patients. Despite many years of infection, their immunological situation is comparable to that of their horizontally infected peers. However, strategies are needed in order to increase engagement in care during transition. 2:30 pm– 4:00 pm Treatment and Monitoring Strategies in Children 919 Long-Term Consequences of Planned Treatment Interruption in HIV-1–Infected Children Riccardo Freguja 1 ; Hahhah Poulson 2 ; Paola Del Bianco 3 ; Alexandra Compagnucci 4 ;Yacine Saidi 4 ; Carlo Giaquinto 5 ; Lynda Harper 6 ; Diana M. Gibb 6 ; Nigel J. Klein 2 ; Anita De Rossi 1 1 1 AIDS Reference Center, Section of Oncology and Immunology, Padova, Italy; 2 Institute of Child Health, London, United Kingdom; 3 Istituto Oncologico Veneto-IRCCS, Padova, Italy; 4 Inserm SC10, Paris, France; 5 Department of Mother and Child Health, Padova, Italy; 6 Medical Research Council, London, United Kingdom Background: The planned antiretroviral treatment interruption (PTI) in children with HIV infection is associated with rapid immunological and virological changes compared to children on continuous therapy (CT) (PENTA 11 trial; Plos One 2013, 10:e76582). After the end of PENTA 11 trial all children were advised to resume ART. The long-term immunological and virological outcomes were evaluated in children for up to 4 years after end of the trial by randomized arm. Methods: 54 children (randomized at main trial baseline: 23 to CT and 31 to PTI arm) entered the long-term substudy. Immunophenotyping of CD4 and CD8 memory and naive cell subsets, thymic output by means of TREC quantification, cell-associated HIV-DNA and HIV-RNA were analysed on available samples at 1, 2, 3, and 4 years after the end of the trial. Results: The median baseline age was 9.0 years and median follow-up was 6.1 years. At 1 year follow-up, levels of cell-associated HIV-DNA were higher in PTI than in CT children (295 vs 70 copies/10*6cells; p=0.035) as were the proportion of children with detectable HIV-RNA in plasma (35% vs 6%; p=0.046). Mean [95% CI] CD4 cells were lower in PTI than CT (708[578-837] vs 876 [738-1014] cells/mm 3 ; p=0.082) as were the percentage of CD4 memory cells out of the total lymphocytes (12.6[9.8-15.4] vs 19.3[15.7-22.9]; p=0.0045). CD4 naive cells did not significantly differ between the two groups (21.3[17.5-25.2] vs 19.0[14.1-24.0]), and TREC levels were higher in PTI arm (2551[2049-3054] vs 1855[1283-2428] copies/10*5cells; p=0.073). CD8 cells tended to be higher in PTI than CT (37.7[33.8-41.5] vs 33.0[28.8-37.2]; p=0.110). At 2, 3 and 4 year follow-up, none of the above parameters significantly differed between PTI and CT, except for the percentage of CD4 memory cells which continued to be lower in PTI than CT at 4 years follow-up (14.8[12.0-17.5] vs 21.0[17.5-24.6]; p=0.0064). Cell-associated HIV-RNA was higher in PTI than CT children (3.01 vs 2.70 log 10 copies/10*6 cells), consistent with a higher level of productive infection in the former. Conclusions: Most of the short term immunological and virological consequences of PTI were still present 1 year after the end of the trial, but no longer detectable after 2 years follow-up. Interestingly, CD4 memory cells continued to be lower in PTI children. While thymic output may compensate for loss of naive CD4 cells, the persistent depletion of CD4 memory cells may result from higher residual productive infection in PTI than in CT children. 920 Can CD4 Monitoring in Virologically Suppressed Children be Reduced or Stopped? Mary-Ann Davies 1 ; Helena Rabie 2 ; Geoff Fatti 3 ; Kathryn Stinson 1 ; Karl-Günter Technau 4 ; Shobna Sawry 5 ; Brian Eley 6 ; Lynne Mofenson 7 ; Andrew Boulle 1 ; IeDEA Southern Africa 8 1 University of Cape Town, Cape Town, South Africa; 2 University of Stellenbosch, Cape Town, South Africa; 3 Kheth’Impilo, Cape Town, South Africa; 4 University of the Witwatersrand, Johannesburg, South Africa; 5 University of Witwatersrand, Johannesburg, South Africa; 6 University of Cape Town, Cape Town, South Africa; 7 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, US; 8 Univeristy of Cape Town and University of Bern, Cape Town, South Africa Background: Although studies suggest CD4 monitoring can be reduced in adults on antiretroviral therapy (ART) with viral suppression after initial CD4 recovery, there are limited data in children, particularly in resource-limited settings. We evaluated probability of CD4 decline in children with viral suppression and CD4 recovery after 1 yr on ART in southern Africa. Methods: Children initiating ART at IeDEA-SA sites with routine HIV-RNA monitoring were included if: WEDNESDAY, FEBRUARY 25, 2015 Session P-U4 Poster Session Poster Hall

Poster Abstracts

552

CROI 2015