CROI 2016 Abstract eBook

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Poster Abstracts

months since 2006. Persistent renal dysfunction was defined by having >2 records of any of 1) estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 for age and height adjusted, 2) increased Cr for age; Cr >0.7 mg/dl for aged 10-12 years and Cr >1.0 mg/dl for aged >13 years, or 3) proteinuria by a dipstick method >1+. Prevalence and incidence of PRD were analyzed. Predictors of persistent RD were assessed by logistic regression. Results: Data of 255 adolescents were included. In their last visit, median (IQR) of age and duration of ART were 16.7 (14.5-18.8) and 10.3 (7.1-12.4) years, respectively. 56% used boosted protease inhibitors (PI)-based regimen and 64% used tenofovir disoproxil fumarate (TDF) with median (IQR) duration of 3.0 (1.4-4.0) years. Median (IQR) of current CD4 was 678 (478-915) cells/mm 3 and 74% had HIV-RNA <50 copies/mL. The overall prevalence of PRD was 14.1% (95% CI 9.8 –18.4), owing to low eGFR and/or increased serum Cr 9% and proteinuria 6.3%. The prevalence of PRD in TDF vs non-TDF group was 18.3% vs 6.7% (p=0.02). Three adolescents (10%) who took TDF and had PRD needed to discontinue TDF. By multivariate analysis, predictors of PRD were age <15 years (aOR 5.7; 95%CI; 2.5-12.8), male (aOR 3.1; 1.4-7.0), exposed cotrimoxazole >3 years (aOR 5.3; 1.7-16.2). In overall, incidence of PRD was 4.4 (95% CI 3.2-6.1) per 100 person-years. Table 1 shows the incidence of PRD by duration of TDF exposed and by type of regimens. Conclusions: Renal dysfunction is not uncommon in the perinatally HIV-infected adolescents. Creatinine and urine analysis monitoring should be emphasized on young adolescents using TDF with protease inhibitors especially in the first 3 years of TDF initiation.

858 Early Weight and Height Changes in Asian Children Using CotrimoxazoleWith ART David C. Boettiger 1 ; Dina Muktiarti 2 ;Truong Huu Khanh 3 ; Suneeta Saghayam 4 ;Torsak Bunupuradah 5 ; Ly Penh Sun 6 ; Rawiwan Hansudewechakul 7 ; LamVan Nguyen 8 ; Azar Kariminia 9 ; for theTREAT Asia Pediatric HIV Observational Database group 1 Univ of New South Wales, Sydney, Australia; 2 Cipto Mangunkusumo General Hosp, Jakarta, Indonesia; 3 Children’s Hosp 1, Ho Chi Minh City, Vietnam; 4 YRG Cntr for AIDS Rsr and Educ, Chennai, India; 5 HIV-NAT, Thai Red Cross AIDS Rsr Cntr, Bangkok, Thailand; 6 Natl Cntr for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia; 7 Chiang Rai Prachanukroh Hosp, Chiang Rai, Thailand; 8 Natl Hosp of Ped, Hanoi, Vietnam; 9 Kirby Inst, Sydney, Australia Background: Cotrimoxazole (CTX) prophylaxis is indicated for most HIV-infected children starting antiretroviral therapy (ART) in resource-limited settings. In addition to protecting against a range of opportunistic infections, CTX also slows the loss of weight- (WFA) and height-for-age (HFA) when ART is not available. However, it is uncertain if CTX enhances growth during the early stages of ART use. Methods: Children enrolled in the TREAT Asia pediatric HIV Observational Database who initiated ART after 31/Dec/2002 aged 1 month - 14 years and had both weight and height documented at ART initiation (baseline) were included. Follow-up was censored at the time of CTX cessation for children using CTX at baseline; the time of CTX initiation for those not using CTX at baseline; or the last recorded clinic visit. Generalized estimating equations adjusted for country income status and including an interaction between CTX use and time were used to identify factors associated with change in WFA and HFA from baseline during the first 24 months of ART. Results: Overall, 3217 children were eligible for analysis. At ART initiation, 76.4%were using CTX prophylaxis, median age was 5.5 years, 50.9%were male, median WFA z-score was -2.5, and median HFA z-score was -2.4. Median baseline CD4 was 27% in both CTX users and non-users. Amongst CTX users, the median duration of CTX use after starting ART was 1.2 years. Smaller increases in WFA z-score were associated with older age at baseline, higher baseline WFA, anemia, and lower CD4%. Using a broad spectrum antibiotic (other than CTX) was associated with greater increases in WFA z-score. The adjusted mean increase in WFA z-score became significantly higher in CTX users compared with non-users after 6 months of ART (0.64 [95%CI 0.59-0.70] vs 0.23 [0.16-0.30], p<0.01) and remained significantly higher thereafter (Figure 1). Older age at baseline, higher baseline HFA, double orphanhood, anemia, and low CD4%were associated with smaller increases in HFA z-score. The adjusted mean increase in HFA z-score became significantly higher in CTX users compared with non-users after 15 months of ART (0.41 [95%CI 0.36-0.46] vs 0.24 [0.17-0.31], p=0.02) and remained significantly higher at 24 months. Conclusions: CTX prophylaxis was associated with greater increases in WFA and HFA during the first 24 months of ART in this Asian cohort of HIV-positive children. Wider use of CTX may compliment ART and nutritional intervention programs for children entering HIV care in the region.

Poster Abstracts

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CROI 2016