683 
Long-term Clinical and Biological Outcomes in Children Vertically Infected with HIV
Catherine Dollfus*1, J Le Chenadec2, A Faye3, S Blanche4, C Rouzioux4, J Tricoire5, G Firtion6, E Lachassinne7, J Warszawski8, and the French Pediatric Cohort EPF
1Hosp Trousseau, AP-HP, Paris, France; 2INSERM U569, Univ Hosp Bicêtre, Le Kremlin-Bicêtre, France; 3Hosp Robert Debré, Paris, France; 4Ctr Hosp Univ Necker, Paris, France; 5Hosp Paule De Viguier, Toulouse, France; 6Maternité Port Royal, Paris, France; 7Hosp Jean Verdier, Bondy, France; and 8INSERM U569, Bicetre Hosp, Le Kremlin-Bicêtre, France
Background: Few clinical and
biological data are available for adolescents living with HIV infection since
birth. We aimed to describe the characteristics at last medical visit of
children born before 1993, included in the EPF cohort and still alive in 2003.
Methods: Prospective follow-up since
birth of infected children included in a nationwide cohort since 1986. Analysis
of the subgroup of children and adolescents still alive, born before 1993, whose
most recent medical visit took place after 2002. Percentages were estimated
with 95% confidence intervals (95%CI) for categorical variables and medians
with interquartile range (IQ) for continuous variables.
Results: Of the 530 infected children
followed in this cohort, 155 (84 boys and 71 girls) met the criteria for this
analysis, with a median age at last visit of 13 years (IQ 12 to 15 years). The
mothers of these children originated from sub-Saharan Africa in 28% of cases, and
from the Caribbean in 12%. A history of CDC
category C diagnosis was reported for 19% of the children. Most (91%) were
initially treated with zidovudine mono-therapy. ART was initiated in the first
year of life in 55% of cases. Subsequently, and at various ages, 86% of the children
received HAART (32% between the ages of 3 and 6 years). At last visit, 74% were
receiving multitherapy, 19% received no ART and 7% were maintained on bi-therapy.
Half the current HAART consisted of a combination of nucleoside analogs with
boosted protease inhibitors. Median height and weight z scores at last visit were
respectively: –0.6 (IQ –1.3 to +0.3) and –0.4 (IQ –1.3 to +0.3). The median CD4
T cell percentage was 29% (IQ 20 to 39) at first ART. It was 27% (IQ 19 to 33) at
last visit, with a minority of children having CD4 percentage <15: 13% (95%CI 7.7 to 17.3). The last median CD4
cell count was 587 (IQ 392 to 844). The last median viral load was 289
copies/mL (IQ 25 to 12,500). Viral load was <400 copies/mL for 53% (95%CI
44.7 to 59.2) of children, and >100,000 copies/mL for 5% (95%CI 1.5 to 7.8)
only.
Conclusions: EPF is one of the largest cohorts
of children followed in the long term since birth. Despite a long period of
suboptimal ART, most of the young adolescents still alive are in a good clinical,
immunological, and virological state.
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