CROI 2016 Abstract eBook

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Poster Abstracts

845 12-Month Treatment Outcomes Amongst HIV-Positive Orphans and Nonorphans Cheryl J. Hendrickson 1 ; Alana Brennan 2 ; Denise Evans 1 ; Ian M. Sanne 3 ; Sharon Patz 4 ; Sanlie Untiedt 5 ; Jean Bassett 5 ; Matthew P. Fox 2 1 Hlth Economics and Epi Rsr Office, Johannesburg, South Africa; 2 Boston Univ, Boston, MA, USA; 3 Univ of the Witwatersrand, Wits Hlth Consortium, Johannesburg, South Africa; 4 Alexandra Clinic, Alexandra, South Africa; 5 Witkoppen Hlth And Welfare Cntr, Johannesburg, South Africa Background: The AIDS epidemic has resulted in a large population of orphans in South Africa – without parents, these children may be more at risk of delayed healthcare and poorer outcomes. Little research has investigated treatment outcomes for HIV-positive orphans versus non-orphans; the research that has been done shows mixed results. We sought to evaluate the association between orphan status and antiretroviral treatment (ART) treatment outcomes among HIV-positive infants, children and adolescents initiating ART at 2 large public-sector HIV clinics in Johannesburg, South Africa. Methods: Retrospective cohort study among HIV-positive infants, children and adolescents aged one month to 18 years initiating on standard first-line ART between June 2004-May 2013. We used modified Poisson regression to evaluate the association of orphan status with all-cause mortality, loss to follow-up (LTF;≥3 months late for a scheduled visit) and having a detectable viral load (≥400 copies/ml) at 12 months on ART. Results: We included 244 (27.1%) patients classified as orphans (either maternal, paternal or both) and 658 (72.9%) as non-orphans at ART initiation in our analysis. Median ages were 8.5 years (IQR:5.2-11.6) and 3.0 years (IQR:1.0-7.4) for orphans and non-orphans, respectively. At ART initiation about 36%were classified as WHO stage III/IV and 17% had TB. A total of 1 (0.4%) orphan and 16 (2.4%) non-orphans died in the first 12 months following ART initiation while 7.8% and 17.8% of orphans and non-orphans were LTF. A total of 37 (18.7%) orphans and 133 (29.4%) non-orphans had a detectable viral load after 12 months on ART. Adjusted modified Poisson regression (Table 1) showed that being an orphan has a protective effect on the risk of death (RR 0.26;95%CI:0.20-0.35), risk of LTF (0.60;95%CI:0.44-0.82) and risk of failure to achieve viral suppression (0.77;95%CI:0.70-0.84) when compared to non-orphans. Conclusions: Results show that orphans were less likely to die, be lost to follow-up and fail to achieve viral suppression. This surprising result needs to be analysed further, but may arise from orphans being more integrated into care due to orphan-specific programming or foster care. Understanding the impact of orphan status on short- and long-term ART outcomes could improve targeted strategies, and subsequent treatment and developmental outcomes, for HIV-positive infants, children and adolescents. Additional research investigating age-specific outcomes will be important to further elucidate these effects.

Table 1. Adjusted predictors of mortality, loss to follow up and viral suppression among infants, children and adolescents 12 months a^er ini-a-ng ART

Adjusted risk ra-o and 95% confidence interval (CI) Mortality (n=17) Loss to follow-‐Up (n=136) Failure to achieve viral suppression (n=170)

Orphan status at ART ini-a-on Non-‐orphan

Reference

Orphan

0.26 (0.20-‐0.35)

0.60 (0.44-‐0.82)

0.77 (0.70-‐0.84)

Sex

Female

Reference

Male

0.95 (0.47-‐1.92)

0.94 (0.81-‐1.09)

1.08 (1.00-‐1.16)

Age at ART ini-a-on (years) < 1 year

0.94 (0.40-‐2.22)

1.06 (0.83-‐1.36)

1.32 (1.08-‐1.62)

1 to 4.9 5 to 9.9

Reference

0.47 (0.40-‐0.55) 0.60 (0.26-‐1.33)

0.51 (0.30-‐0.85) 0.40 (0.18-‐0.86)

0.65 (0.27-‐1.56) 0.99 (0.88-‐1.12)

≥ 10 years

CD4 classifica-on at ART ini-a-on* Very low

4.30 (3.19-‐5.81) 0.43 (0.29-‐0.63) 0.47 (0.11-‐1.93)

1.78 (1.69-‐1.89) 0.91 (0.56-‐1.49) 0.95 (0.84-‐1.07)

0.91 (0.58-‐1.42) 0.96 (0.94-‐0.98) 0.94 (0.80-‐1.10)

Low

Moderate

High

Reference

Poster Abstracts

Hb at ART ini-a-on (ug/dL) < 10

Reference

≥ 10

0.64 (0.59-‐0.69)

0.99 (0.71-‐1.36)

0.96 (0.78-‐1.19)

WHO clinical stage at ART ini-a-on I or II

Reference

III or IV

0.97 (0.63-‐1.48)

0.82 (0.73-‐0.92)

1.21 (1.10-‐1.32)

NRTI

Stavudine (d4T) or

Reference

Zidovudine (AZT)

Abacavir (ABC) or Tenofovir

0.41 (0.21-‐0.79)

1.18 (1.11-‐1.24)

2.56 (1.88-‐3.48)

(TDF)

PI**

No Yes

Reference

1.89 (0.90-‐3.99)

0.69 (0.68-‐0.70)

0.97 (0.96-‐0.99)

*CD4 classificaZon as follows: Very low CD4:<5% for <6 and <25 cells/mm3 for ≥6; Low CD4:5-‐15% for <6 and 25-‐50 cells/mm3 for ≥6; Moderate CD4:15-‐25% for <6 and 50-‐200 cells/ mm3 for ≥6; High CD4:>25% for <6 and >200 cells/mm3 for ≥6 **PI is either Lopinavir or Ritonavir

846

An Audit of Weight-Based Antiretroviral Therapy Dosing in Children Subathira Dakshina 1 ; Lavanya Raman 2 ; Rashida A. Ferrand 3 ; PalwashaY. Khan 4 ; Katharina Kranzer 3 ; Hilda Mujuru 5 1 Barts Hlth NHS Trust, London, UK; 2 Southend Univ Hosp, Westcliff on Sea, UK; 3 London Sch of Hygiene & Trop Med, London, UK; 4 London Sch of Hygiene & Trop Med, Cardiff, UK; 5 Univ of Zimbabwe, Harare, Zimbabwe Background: Paediatric antiretroviral therapy (ART) dosing is weight dependent and guidelines recommend ART dose adjustment according to a child’s weight. We conducted an audit to assess ART dosing in a public sector paediatric HIV outpatient clinic in Harare, Zimbabwe. At this clinic children are routinely reviewed by a clinician every three months. Methods: Children and guardians consecutively attending the HIV clinic fromMay to July 2015 at Harare Hospital were enrolled with consent. Data was extracted from patient- held and clinic records including date of ART initiation, current CD4 count, ART regimen, ART dosage, weight and changes to ART regimen and/or dose at the last clinic (doctor) visit. Correct weight-based dosing was defined according to the National ART Guidelines. The proportion of children with incorrect dosing (either over-dosed or under-dosed) at the time of the clinic visit was determined for each drug.

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CROI 2016

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