CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Glomerular dysfunction is common in our HIV-infected adolescents, particularly among TDF users. Monitoring of glomerular function is important in the routine clinical practice, and should be considered in individuals at risk.

851 VIROLOGIC RESPONSE TO EFAVIRENZ-BASED FIRST-LINE IN CHILDREN BY PMTCT EXPOSURE STATUS Lee Fairlie 1 , Patience Nyakato 2 , Mary-Ann Davies 2 , Karl Technau 3 , Geoffrey Fatti 4 , Helena Rabie 5 , Frank Tanser 6 , Andrew Boulle 2 , Robin Wood 2 , Brian Eley 2 , Shobna Sawry 1 , Janet Giddy 7 , Nosisa Sipambo 3 , Andreas D. Haas 8 , Louise Kuhn 9 1 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 2 University of Cape Town, Cape Town, South Africa, 3 University of the Witwatersrand, Johannesburg, South Africa, 4 Kheth’Impilo, Cape Town, South Africa, 5 Stellenbosch University, Cape Town, South Africa, 6 University of KwaZulu-Natal, Durban, South Africa, 7 McCord Hospital, Durban, South Africa, 8 University of Bern, Bern, Switzerland, 9 Columbia University, New York, NY, USA Background: WHO recommends an efavirenz (EFV)-based first-line regimen for children ≥3 years of age starting antiretroviral therapy (ART), despite the possible risk of resistance with prior exposure to non-nucleoside reverse transcriptase inhibitors for prevention of mother-to-child transmission (PMTCT). We aimed to investigate the association between PMTCT exposure and virologic outcomes in children ≥3 years starting EFV-based ART using routine data from the International epidemiology Databases to Evaluate AIDS (IeDEA). Methods: We included children aged 3-13 years who initiated EFV-based ART between 2004 and 2014, and had ≥2 viral load (VL) measures from 4-18 months on ART at 10 IeDEA public sector ART programs in South Africa. PMTCT exposure status was recorded by the program at enrolment as exposed, unexposed or unknown. Exact PMTCT regimens were not routinely recorded. We used logistic regression to examine the association between recorded PMTCT exposure and VL >1000 copies/ml (cpm) between 4-18 months on ART adjusting for patient characteristics associated with viral outcomes and calendar year. In additional analyses we assumed PMTCT exposure for those where exposure was unknown as either (1) all exposed to South African PMTCT guidelines at the time of the child’s birth or (2) all unexposed. Results: The median age at ART start of 8,383 children included was 7.5 years; 50%were girls. Recorded PMTCT exposure was as follows: 67% unexposed, 7% exposed and 26% unknown. VL >1000 cpmwas experienced by 23% of children. Children with PMTCT exposure had similar risk of VL >1000 cpm compared to unexposed children (adjusted Odds Ratio [aOR]: 0.9; 95% CI:0.66, 1.24), but children with unknown PMTCT exposure were less likely to have VL >1000 cpm (aOR: 0.75; 95% CI:0.64, 0.88) (Table). After assuming children with unknown exposure received PMTCT available according to South African guidelines, PMTCT exposed children were less likely to have VL >1000 cpm compared to unexposed children (aOR:0.74; 95%CI: 0.61, 0.89). When assuming no PMTCT exposure for those with unknown exposure, PMTCT was not associated with VL >1000 cpm. Starting ART in more recent calendar years had a higher risk of VL >1000 cpm (Table). Conclusion: In our study previous PMTCT exposure was not associated with poorer virologic outcomes in children >3 years starting EFV-based ART. Further research is needed to understand the effect of calendar year on VL outcomes.

852 VIRAL SUPPRESSION IN HIV-INFECTED CHILD-CAREGIVER DYADS IN WESTERN KENYA John M. Humphrey 1 , Beverly Musick 1 , Edith Apondi 2 , Becky L. Genberg 3 , Adrian Gardner 1 , Joseph Hogan 4 , Kara K. Wools-Kaloustian 1 1 Indiana University, Indianapolis, IN, USA, 2 Moi University, Eldoret, Kenya, 3 Johns Hopkins Hospital, Baltimore, MD, USA, 4 Brown University, Providence, RI, USA Background: Despite the role of caregivers (CG) in managing children with HIV, viral suppression in child-caregiver dyads in which both individuals are HIV-infected is not well characterized. We explored viral suppression in dyads enrolled in the Academic Model Providing Access to Healthcare (AMPATH) program in Kenya. Methods: We analyzed medical records of all HIV-infected children < 15 years of age linked to HIV-infected CGs, who both received HIV care at an AMPATH clinic between 1/2015 and 2/2017. To be included in the analysis, children and CGs must have had ≥ 1 viral load (VL) within the study window and at least 6 months after ART initiation. For dyads with > 1 VL within the window, the child and CG VLs in closest temporal proximity to each other were chosen for analysis. The characteristics of children, CGs, and dyads were summarized with descriptive statistics. Odds ratios (OR) were calculated to determine the association of viral non-suppression (defined as VL ≥ 1000 copies/mL) among children and CGs. Results: Of 7,669 children who received HIV care at AMPATH during the study window, 5,278 met the inclusion criteria. Of these, 2,912 (55%) were linked to a CG, and 2,154 (74%) CGs also met the inclusion criteria (n=2,154 dyads). Overall, 93% of CGs were mothers, median [IQR] age at HIV care enrollment was 32 [27, 36] years, median CD4 count at ART initiation 165 cells/uL [88, 259], and median years since ART initiation 5.9 [3.7, 8.0]. For children, 52%were girls, median age at enrollment was 3 [1.3, 5.3] years, median CD4% 15% [10, 22] (< 5 years at ART initiation), median CD4 count 382 [228, 686] (≥ 5 years at ART initiation), and median years since ART initiation 4.9 [2.6, 6.7]. The median number of days between caregiver and child VLs was 15 [0, 81]; child and CG VLs occurred on the same day in 44% of dyads. CG-child viral suppression was: both suppressed (56%), CG suppressed and child unsuppressed (23%), CG unsuppressed and child suppressed (10%), and both unsuppressed (11%). Children with unsuppressed CGs were 3 times more likely (OR=2.8, 95% CI: 2.3-3.5) than children with suppressed CGs to have unsuppressed VL. Conclusion: Children with CGs who have unsuppressed VLs are at higher risk of viral non-suppression. Further research is needed to understand the barriers to viral suppression within the context of these family environments and identify interventions to address these barriers. Careful monitoring should be initiated for children who have HIV-infected CGs who are not suppressed.​ 853 ARE HIV+ MIGRANT CHILDREN IN EUROPE AT INCREASED RISK OF POOR OUTCOMES ON ART? Malte Kohns 1 , Ruth Goodall 2 , Luisa Galli 3 , Ali Judd 2 , Tessa Goetghebuer 4 , Antoni Noguera-Julian 5 , Laura Rodrigues 1 , Henriëtte J. Scherpbier 6 , Intira J. Collins 2 1 London School of Hygiene & Tropical Medicine, London, UK, 2 University College London, London, UK, 3 University of Florence, Florence, Italy, 4 Saint-Pierre University Hospital, Brussels, Belgium, 5 Hospital Sant Joan de Déu Barcelona, Esplugues, Spain, 6 Emma Children’s Hospital/Academic Medical Center, Amsterdam, Netherlands Background: HIV-infected adult migrants in Europe have increased risk of AIDS and poorer response to antiretroviral therapy (ART) compared to domestic- born patients. There are few comparable studies in children.

Poster Abstracts

CROI 2018 322