412. Cumulative Viremia-Copy Years Predicts Morbidity and Mortality in Perinatally HIV-Infected Children
Session: Poster Abstract Session: Pediatric HIV
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA poster.pdf (636.4 kB)
  • Background:

    Plasma HIV viral load (VL) measures have been an integral part of HIV clinical practice for 2 decades.  VL  has been used as a cross-sectional measure, clinically and analytically.  Although, a single VL measure has demonstrated value in clinical and prevention research, it fails to demonstrate an individual’s cumulative exposure to viral replication over time.  We evaluated the cumulative effect of exposure to plasma HIV VL on morbidity and mortality in perinatally HIV-infected children.  


    This is a retrospective review of medical records of perinatally HIV-infected children who were followed in the Yale-New Haven Hospital Pediatric HIV Clinic between 1996 and 2012.   The primary study outcomes were morbidity and mortality.  We extracted the following explanatory variables: HIV VL, CD4+ count and significant past medical events such as interval illnesses, hospitalizations and death.   The cumulative VL burden was measured as viremia copy-years (VCY), i.e. the number of copies of HIV RNA per mL accumulated over time.  Data were summarized using descriptive statistics and primary analysis was conducted using Cox proportional hazard modeling.


    Our study subjects comprised 70 perinatally HIV-infected children who had ≥ 3 VL measures.  They were followed for a median of 14.5 years and contributed a total of 918 person-years of follow-up.  There was a median 37 VL measures per patient.  The mortality rate was 23% (1.7 per 100 person years).  For each log10 increase in VCY, the risk of mortality increased 15-fold (95% CI = 4.20 – 53.4).  There was a strong correlation between each log10 increase in VCY with number of hospital admissions and number of AIDS defining illnesses (p<0.0001).  The mortality rate was significantly greater for patients with >5 log10 VCY than those with <5 log10 VCY.  After adjusting for most recent CD4+ count, gender and race, hazard risk (HR) for morbidity and mortality was 8.5 (95% CI = 2.1 – 34.3) for each log10 increase in VCY (p=0.003). 


    Viremia copy-years, a measure of cumulative plasma HIV RNA exposure and viral replication demonstrates strong association with morbidity and mortality in perinatally HIV-infected children.

    Olafur Thorvaldsson, MD1, Elijah Paintsil, MD1, Veronika Northrup, MPH2 and Warren Andiman, Professor1, (1)Pediatric Infectious Disease, Yale University School of Medicine, New Haven, CT, (2)Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT


    O. Thorvaldsson, None

    E. Paintsil, None

    V. Northrup, None

    W. Andiman, None

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