CROI 2015 Program and Abstracts

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Poster Abstracts

937 Sleep Disturbances in a Cohort of HIV-Infected Children and Adolescents on Antiretroviral Treatment: NeuroCoRISpeS Cristina García-Navarro 1 ; Santiago Jiménez de Ory 2 ; Maria Luisa Navarro Gomez 2 ; JoséTomás Ramos Amador 6 ; Maria Jose Mellado 3 ; Luis Prieto 5 ; Pablo Rojo Conejo 1 ; Esmeralda Nuñez 4 ; María Isabel González-Tomé 1 On behalf of the CoRISpeS‚ÄìMadrid Cohort 1 Hospital Universitario 12 de Octubre, Madrid, Spain; 2 Hospital Universitario Gregorio Marañón, Madrid, Spain; 3 Hospital Universitario La Paz, Madrid, Spain; 4 Hospital Regional Universitario Carlos Haya, Malaga, Spain; 5 Hospital Universitario de Getafe, Getafe, Spain; 6 Hospital Universitario Clinico San Carlos, Madrid, Spain; 7 Madrid, Madrid, Spain Background: Sleep disorders have been reported in adults with HIV infection with a prevalence of at least 30%. Sleep quality (SQ) is very important in children and their daily functioning, although in HIV pediatric population scarce data are avalaible. Our objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART). Methods: HIV infected children and adolescents due to vertical transmission between 4 and 23 years old. They belonged to a national cohort (CoRISpeS) and were followed according to a standard protocol in several hospitals in Spain. Clinical characteristics, ART and adherence were registered. SQ was assessed through Pittsburgh Sleep Quality Index (PSQI), a questionnaire validated in Spanish population which assesses SQ and disturbances over a month. It scores for 7 components and one global score, distinguishing between good and poor sleepers. For the analysis, we divided the sample into two groups according to the treatment they were receiving (NRTI+NNRTI vs NRTI+PI) in order to assess the influence of ART profile. Univariate and multivariate analysis (logistic regression) were performed. Results: 59 patients were evaluated. Median age: 16y (4,23), age at start of ART: 0.62y (0,14), 66% females, 63% caucasian, AIDS CDC category: 33.9% (13.6% encephalopathy). Median CD4 at baseline: 35% (1,59), CD4/CD8 1.0 (0,3.28), nadir CD4: 15% (0.5,45). Viral load <50cop/ml: 84.7%. Median time on HAART: 11.32 years (0.51,17). The most frequent regimen was 2NRTI+1NNRTI (46%, Efavirenz 43.9%), followed by 2 NRTI+1PI (41%). Good adherence: 83%. No differences were found in clinical and immunovirological variables or time of exposure to ART between both groups. We found poor SQ in 24%, being the most frequent complaints: Sleep disturbances (76.3%), Sleep latency (59.3%), Subjective SQ (57.6%) and Daytime dysfunction (51.8%). There were relationship between the use of NNRTI and Sleep latency (p=.006) and Habitual sleep efficiency (p=.031). Specifically, patients who took EFV presented longer sleep latency (p=.026). Age was also related to poorer SQ (p=.005). When we adjusted the analysis for age, relationship between the use of NNRTI and poorer SQ remained: Sleep latency (p=.027) and Efficiency (p=.088). Conclusions: In our cohort sleep complaints are common. Mainly NNRTI and EFV seem to have an impact on SQ compared to PI regimens. We consider these results important in pediatric population due to the influence in daily functioning, school and cognitive performance. Melissa A. Briggs 1 ; Andrew Auld 1 ; Harrison Kamiru 2 ; Harriet Nuwagaba-Biribonwoha 2 ;Velephi Okello 3 ; George Bicego 1 ; Andrew L. Baughman 1 ; Simon Agolory 1 ;TeddV. Ellerbrock 1 ; Peter Ehrenkranz 4 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 Mailman School of Public Health, New York, NY, US; 3 Swaziland Ministry of Health, Mbabane, Swaziland; 4 US Centers for Disease Control and Prevention (CDC), Mbabane, Swaziland Background: Tuberculosis (TB) is the most common preventable cause of death in people living with HIV (PLHIV). Screening for TB and treating it are therefore key life-saving measures in HIV care settings, especially in Swaziland where over 75% of TB cases are amongst PLHIV. This study evaluated the implementation of TB screening in children initiating antiretroviral therapy (ART) in Swaziland and assessed predictors of TB disease amongst those who developed TB after ART initiation. Methods: We performed a retrospective chart review on a nationally representative sample of children ≤ 14 years old, who initiated ART during 2004–2010. Twelve of 28 ART clinics were selected using probability-proportional-to-size sampling; at these 12 clinics, charts were selected by simple random sampling. Data were weighted and survey procedures used to account for study design. Multivariable Cox proportional hazards regression was used to determine adjusted hazard ratios (aHRs) for potential predictors of incident TB. Results: Of 2,008 ART enrollees included in the sample, 984 (49%) were female, median age was 5.0 (interquartile range: 1.6–8.8), and 168 (8%) were receiving TB treatment at the time of referral to the ART clinic. Among the 1,840 children not already receiving TB treatment, 349 (19%) had documentation of screening for ≥ 1 of five recommended TB symptoms prior to ART initiation. The proportion of patients screened for ≥ 1 TB symptom increased from 0/37 (0%) in 2004 to 154/559 (30%) in 2010 (p=0.004). Of the 349 screened, 135 (47%) were positive for cough, and 62 (19%) subsequently received TB treatment. After ART initiation, an additional 143 (7%) of all 2,008 children were diagnosed with TB. Significant predictors of TB post-ART initiation included age ≥ 5yrs (aHR 1.7; 1.2–2.3; reference <2 years), World Health Organization Stage IV (aHR 2.8; 1.1–7.0; reference stage I/II), and TB treatment at ART initiation (aHR 1.7; 1.1–2.5). Conclusions: TB is common among children initiating ART in Swaziland. Although TB screening is improving, over two-thirds of children starting ART in 2010 were not screened. Older age, more advanced HIV/AIDS, and TB treatment at ART start were predictive of incident TB, the latter possibly indicating sub-optimal TB cure or ongoing TB transmission within the child’s household. Further program strengthening is needed to ensure that all pediatric patients initiating ART are screened for TB, and that best-practice measures are used to prevent relapse or recurrence of TB disease. 939 Mycobacterium TB Disease in HIV-Infected Children Receiving LPV/r or NVP-Based ART Moherndran Archary 1 ; Linda Barlow-Mosha 2 ; AvyViolari 3 ; Jane Lindsey 4 ; Lynne Mofenson 4 ; Patrick Jean-Philipe 4 ; Bonnie Zimmer 4 ; Paul E Palumbo 5 1 University of KwaZulu-Natal, Durban, South Africa; 2 MUJHU Care Ltd/MUJHU Research Collaboration, Kampala, Uganda; 3 Perinatal HIV Research Unit, Johannesburg, South Africa; 4 Frontier Science, Amherst, NY, US; 5 Geisel School of Medicine at Dartmouth, Lebanon, NH, US Background: In high TB burden countries, HIV-infected children are at risk of developing Mycobacterium tuberculosis (MTB) disease due to impaired immunity. We describe the incidence, clinical spectrum, antiretroviral (ART) management, adverse events and virologic suppression rates of children on ART initiating anti-TB therapy in IMPAACT P1060 Methods: IMPAACT P1060 was conducted at 9 sites in Africa and 1 in India. HIV-infected children (2m - 3yr) with no TB were randomized to NVP or LPV/r-based ART. Children developing incident TB during the study were taken off study drug and placed on alternative ART as per national guidelines, but remained in study follow-up. Poisson regression was used to test for differences in TB incidence rates by baseline characteristics and over time and McNemar’s test to assess virologic suppression rates before and after TB therapy. WEDNESDAY, FEBRUARY 25, 2015 Session P-U8 Poster Session Poster Hall 2:30 pm– 4:00 pm Tuberculosis and Other Coinfections in ChildrenWith HIV 938 Tuberculosis Among Children on Antiretroviral Therapy in Swaziland, 2004-2012

Poster Abstracts

562

CROI 2015