CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Rare, intact proviruses could be detected in the blood of children who initiated ART after 2.3 months of age. The frequency of intact proviruses is similar to that reported for adults treated during early HIV infection.

808 SLOW CD4/CD8 RATIO RECOVERY AMONG CHILDREN AND ADOLESCENTS DESPITE VIRAL SUPPRESSION Win Min Han 1 , Tanakorn Apornpong 1 , Watsamon Jantarabenjakul 2 , Sivaporn Gatechompol 1 , Sasiwimol Ubolyam 1 , Stephen J. Kerr 1 , Anchalee Avihingsanon 1 , Kiat Ruxrungtham 2 , Praphan Phanunphak 3 , Thanyawee Puthanakit 2 1 HIV–NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 2 Chulalongkorn University, Bangkok, Thailand, 3 Thai Red Cross AIDS Research Center, Bangkok, Thailand Background: There are limited data describing long-term outcomes of young adults living with HIV who are successfully treated with combination antiretroviral therapy (cART). We investigated the recovery rates of CD4/CD8 ratio, a suggested marker for chronic immune activation, among Thai children and adolescents after they initiated cART. Methods: This study was carried out in an ongoing HIV Thai cohort that includes children and adolescents (both perinatally [PaHIV] and behaviorally [BaHIV] acquired HIV infections) who had started cART at 5 years of age. CD4/ CD8 normalization was defined as two consecutive values of the ratios ≥1. Participants were eligible for inclusion in this analysis if they achieved and maintained viral suppression at <50 copies/mL after starting cART, and if CD4/ CD8 ratio at first viral suppression was <0.8. Follow-up was censored once participants had viral rebound after achieving suppression. Results: A total of 138 children and adolescents (101 PaHIV and 37 BaHIV) aged <25 years old met inclusion criteria. Among 37 BaHIV adolescents, 27 (73%) were men who have sex with men. Median (interquartile range, IQR) age at ARV initiation was 10.6 (8.1-16.3) years old with median (IQR) baseline CD4 and CD8 cell counts of 178 (37-320) cells/mm³ and 964 (616-1332) cells/mm³, respectively. Median duration of cART was 9.3 years (10.6 for PaHIV and 2.4 for BaHIV) and median duration of virological suppression was 3.1 years (4.7 for PaHIV and 1.8 for BaHIV). Overall CD4/CD8 ratio of children and adolescents at first virological suppression was 0.47 (0.29-0.62). Over 559 person years of follow-up (PYFU), the incidence of CD4/CD8 ratio normalization among children and adolescents <25 years old was 4.1 per 100 PYFU (95% confidence interval [CI]: 2.7-6.2). Using the Kaplan-Meier method, the probabilities of normalization at 2, 5 and 10 years after virological suppression were 5.2%, 22.6% and 35.6%, respectively. After 2 years of virological suppression, the normalization probability of PaHIV children and adolescents was higher but not significantly different than that of BaHIV (11.1% vs. 6%). Conclusion: CD4/CD8 ratio recovery was slow among children and adolescents after initiating cART, despite persistent virological suppression. The clinical consequences of ongoing immune activation among children and adolescents on suppressive cART without CD4/CD8 normalization needs further investigation. 809 UNDERSTANDING THE IMPACT OF ART INTERRUPTION ON THYMIC OUTPUT AND TCR REPERTOIRE Katrine S. Sandgaard 1 , Teresa Attenborough 1 , Ben Margets 2 , Stuart Adams 2 , Deena Gibbons 3 , Mette Holm 4 , Athina S. Gkazi 1 , Nigel Klein 1 1 UCL Great Ormond Street Institute of Child Health, London, UK, 2 Great Ormond Street NHS Foundation Trust, London, UK, 3 King’s College Hospital, London, UK, 4 Aarhus University Hospital, Aarhus, Denmark Background: Antiretroviral therapy (ART) interruptions in adults lead to decreases in CD4+ T cells and an increase in mortality and morbidity. ART

807 POORER CONTROL OF VIRAL LOAD IN PATIENTS INFECTED PERINATALLY VERSUS DURING ADULTHOOD Jean Joel Bigna 1 , Remonie Seng 2 , Albert Faye 2 , Catherine Dollfus 2 , Pierre Frange 2 , Laura Nailler 1 , Jérôme Le Chenadec 1 , Faroudy Boufassa 1 , Asma Essat 1 , Veronique Avettand-Fenoel 3 , Stephane Blanche 2 , Cécile Goujard 2 , Laurence Meyer 1 , Jean- Paul Viard 2 , Josiane Warszawski 1 1 INSERM, Le Kremlin-Bicetre, France, 2 Assistance Publique – Hôpitaux de Paris, Paris, France, 3 Paris Descartes University, Paris, France Background: Combined antiretroviral treatment (cART) allows most HIV- infected infants to reach adulthood. We studied whether the current virological response of perinatally-infected children and young adults to cART was similar to that of patients infected during adulthood, with a similar duration of infection and treatment history. Methods: Data from 5 ongoing French national ANRS cohorts were pooled: 1) patients diagnosed at < 13 years of age, followed as children (EPF-CO10), or as adults (COVERTE-CO19); 2) patients diagnosed at ≥ 15 years of age, included at the time of primary HIV infection (PRIMO-CO6), or diagnosis (COPANA- CO9, SEROCO-CO2). Here we retained all patients diagnosed in the two years following birth for perinatally infected patients or following seroconversion for patients infected during adulthood, under cART for ≥ 6 months at last evaluation, between 2012 and 2017 (respectively: n = 358 and n = 1512). We distinguished 5 strata for the duration of HIV infection, based on relevant time-points for perinatally infected patients: 2-5, 6-12, 13-17, 18-24, and 25-32 years. The main outcome was detectable viral load (HIV RNA ≥ 50 cp/ml) at last evaluation. A multivariate logistic regression was conducted for each stratum to adjust for gender, birth country, and treatment history. Results: At last visit, most patients had been receiving the same cART regimen for six months or more. The use of new-generation drugs varied with age and period of acquisition. The proportion of detectable VL was significantly higher in the youngest children and in the adolescents and young adults infected since birth than in patients infected during adulthood with a similar duration of infection; the difference was lower for perinatally-infected patients ≥25 years (Fig 1). The findings were similar after multivariate analysis (AOR in Fig 1) and when restricting the analyses to patients with no changes in treatment regimen during the previous six months. Conclusion: Among cART-treated patients diagnosed soon after birth or seroconversion, young patients infected perinatally had much poorer viral control than adults with a similar duration of infection, not explained by treatment history, including the number and type of drugs in the context of a European country with universal free access to care. These results may reflect the difficulties of drug administration to younger children and of maintaining adherence during adolescence and young adulthood. The long-term impact of viral replication should be studied.

Poster Abstracts

CROI 2019 314