1122. Strongest immune recovery among perinatally HIV-infected children aged <1 year at time of cART initiation compared to older children: a Dutch cohort study
Session: Poster Abstract Session: Pediatric HIV
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • POSTER ID WEEK.pdf (936.7 kB)
  • Background: Since the introduction of combination antiretroviral therapy (cART), mortality and morbidity in human immunodeficiency virus (HIV)-infected children has decreased drastically. Younger age at cART initiation has been associated with greater CD4 increases, but the literature is not consistent. Our objective was to create an overview of the clinical and long-term immunological response to cART in a Dutch cohort, accurately registered since the introduction of cART in 1996 until 2012.

    Methods: Inclusion criteria were registration by the Dutch HIV Monitoring Foundation (SHM) and perinatal HIV transmission. Immunologic trajectories after cART initiation were compared between different age groups at the start of cART (0-1, 1-5, 5-12, 12-17 years of age), using random effects linear regression with random intercepts and random slopes for each child. Slopes were allowed to vary during the first 5 years after cART initiation.

    Results: In 2012, 19,752 HIV infected patients had been registered by the SHM. From 1996 until May 2012, a total of 282 (1,4%) HIV-infected children were reported, of whom 229 (82%) children were perinatally infected. The majority of children were born in the Netherlands (46%) or Sub-Saharan Africa (SSA) (43%) and born to mothers originating from SSA (64%). Among these children (116 girls, (51%)), the median age at diagnosis was 2.1 years (IQR 0.5-4.9). cART was initiated in 185 children at a median age of 5.8 years (IQR 3.0-9.7). At HIV-diagnosis, 151 (66%) were CDC stage A, 38 (17%) stage B and 40 (18%) stage C. Mortality was very low (only 1 child died). Maximal HIV viral load suppression was noted in >95% of all patients in 2012. Pre-cART CD4 counts were relatively higher among the youngest (0-1 years) children (p<0.001). CD4 counts showed excellent initial response (average of 76% increase in 2 years) in all children. After ten years of follow-up, the youngest children still had a higher CD4 count compared to the older age groups (p<0.0001).

    Conclusion: In this Dutch pediatric cohort, the mortality rate is very low. Long-term virological and immunological response to cART is persistently good, with the youngest age group at cART initiation (0-1 years of age) showing the highest CD4 count recovery in our long term follow up period.

    Sophie Cohen, MD, Pediatric Infectous Diseases, Emma Children's Hospital, Amsterdam, Netherlands, Colette Smit, Ir., PhD, Dutch HIV monitoring foundation, Amsterdam, Netherlands, Dasja Pajkrt, MD, PhD, Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam, Netherlands and Dutch Pediatric HIV Study Group (PHON)

    Disclosures:

    S. Cohen, None

    C. Smit, None

    D. Pajkrt, None

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