Long-term clinical and biological outcomes in children vertically infected with HIV
Polly Clayden, HIV i-Base
Few clinical and biological data are available for adolescents living with HIV since birth.
Since 1986, the French Paediatric Cohort (EPF) prospectively enrolled HIV positive women who delivered at 90 centres across France, and followed all vertically infected children on a long-term basis.
Catherine Dollfus and coworkers from EPF authored a poster presenting an analysis of the subgroup of older children and adolescents still alive in this cohort, born before 1993, with last data collected after January 2003. The authors reported, that of the 293 children born before 1993, 171 children were still alive with a median age of 14.5 years (IQR: 13.0-16.5 years)
About a quarter of children were born to mothers originating from sub-Saharan Africa and 11% from the Caribbean, with the remaining 63% born to Caucasian mothers.
A history of CDC category C diagnosis was reported for 18% of the children, with no difference between genders or ethnicities. The majority of the children (92%) initially received AZT mono-therapy, 56% of children were treated from birth and subsequently 87% children received HAART (36% between the ages of 3 and 7 years).
At last visit, 77% were receiving HAART and 19% dual therapy. Only 3.5% had never received antiretroviral therapy. Of those receiving HAART (n=131), 80 (61%) received 2 NRTI + 1 PI; 26 (20%) received 2 NRTI +1 NNRTI; 5 (4%) received 3 NRTIs and 20 (15%) other combinations.
Overall 60.6% of the children had CD4 count >/= 500 cells/mm3; 31.5% had CD4 count 200-300 cells/mm3 in and 7.9% [95%CI: 3.8-12.0] of children had a CD4 count of <200 cells/mm3.
Viral load was <50 copies/mL in 40.4% [95% CI: 32.9-47.8%] of the children; 50-1000 copies/mL in 16.9% of children; 1000-30,000 in 27.7%, and 15% of children had viral load >30,000 [95% CI: 9.6-20.5] copies/mL
EPF is one of the largest cohorts of children followed in the long term since birth. The authors wrote: Despite a long period of suboptimal antiretroviral treatment, immunological and virological status of most adolescents still alive is rather satisfactory.
It would be interesting to see an analysis of the 20 children receiving other combinations in this subgroup, which would be expected to be more complex and salvage therapy.
Dollfus C, Le Chenadec J, Faye A et al. Long-term clinical and biological outcomes in children vertically infected with HIV. 13th CROI, Denver, 2006. Abstract 683.