Home Search Abstracts Browse Sessions Program Committee E-mail Abstract Author View Session

Session 83 Poster Abstracts
Antiretroviral Agents in Resource Limited Settings
Wednesday, 1:30 - 3:30 pm
Poster Hall


588    
Virologic and Immunologic Response to Highly Active Antiretroviral Therapy among HIV-infected Children in Cote d'Ivoire
F Diomande1, H Lago1, D Hanson2, C Phares*3, F Anthony4, C Maurice1, B Monga1,5, J Nkengasong1,5, M Laga1, E Bissagnéné6, T Ellerbrock7, and M Nolan1,5
1Project RETRO-CI, Abidjan, Ivory Coast; 2CDC, Atlanta, GA, USA; 3Univ. of California, Berkeley, USA; 4Univ. Hosp. of Yopougon, Abidjan, Ivory Coast; 5CDC, Atlanta, GA, USA; 6Drug Access Initiative, Ministry of Hlth., Abidjan, Ivory Coast; and 7CDC, Global AIDS Prgm., Atlanta, GA, USA

Background:  Little information is available about the long-term therapeutic response to highly active antiretroviral therapy (HAART) of children living in Africa. In this analysis, we describe changes in plasma viral loads and CD4 counts and occurrence of adverse laboratory events among children in Côte d’Ivoire, who initiated HAART during 1998 to 2002.

Methods:  We analyzed data from an observational cohort of HIV-1-infected children (<13 years), who were screened and followed in the Drug Access Initiative in Abidjan. For antiretroviral-naive children who initiated HAART, we estimated changes from baseline VL and CD4 counts, using piecewise linear regression, and estimated the probability of developing a severe (grade 3) or life-threatening (grade 4) adverse laboratory event, using modified Kaplan-Meier methodology for interval censored data.

Results:  Of 605 children who were screened, 193 (32%) initiated HAART. Of those initiating HAART, 51% had an AIDS-defining condition, 78% had severe immunosuppression (age-specific immune category 3), 22% had previously taken antiretroviral drugs, and 63% returned to the clinic for at least 1 follow-up visit. For children who initiated HAART and had viral load and CD4 counts at both baseline and follow-up, viral load was an estimated 2.6 log10 copies/mL lower and CD4 count >360 cells/µl higher than baseline values, after 1 year of follow-up. For children, who were free from grade 3 or 4 abnormal laboratory values at baseline and had subsequent laboratory measurements, the cumulative probability of an adverse event was 0.07, 0.11, and 0.14 within 1, 6, and 12 months, respectively, after initiating HAART.

Conclusion:  After initiating HAART, these HIV-infected children had similar virologic and immunologic outcomes and probability of adverse laboratory events as patients enrolled in clinical trials in the United States and Europe. These results suggest that providing HAART for children can be an effective strategy for reducing the burden of HIV disease in Africa.

Keywords: Antiretroviral therapy; HIV/AIDS; Children