910 
Virologic Response to Protease Inhibitor-based ART among Children Younger than 2 Years of Age Co-treated for TB in South Africa
Cordula Reitz*1, A Coovadia2, T Meyers3, C-C Hu1, R Strehlau2, G Sherman4, E Abrams5, and L Kuhn1
1Gertrude H Sergievsky Ctr, Columbia Univ, Mailman Sch of Publ Hlth, New York, NY, US; 2Coronation Women and Children Hosp, Johannesburg, South Africa; 3Chris Hani Baragwanath Hosp, Johannesburg, South Africa; 4Univ of the Witwatersrand, Johannesburg, South Africa; and 5Intl Ctr of AIDS Care and Treatment Prgms, Columbia Univ, Mailman Sch of Publ Hlth and Coll of Physicians and Surgeons, New York, NY, US
Background: South African
guidelines recommend PI-based ART for HIV-infected children <36 months of
age. Lopinavir/ritonavir (LPV/r) is the PI of choice but if co-treatment for TB
is required, ritonavir (RTV) is often substituted. We describe factors associated
with virologic suppression among HIV-infected children initiating PI-based ART,
many of whom also required TB co-treatment
Methods: Treatment-naive
HIV-infected children, ages 6 weeks to 24 months eligible for ART were enrolled
into an ART strategies trial in Johannesburg, South Africa, April 2005 to November
2006. Children >6 months of age received LPV/r + stavudine (d4T) +
lamivudine (3TC). Children <6 months or receiving co-treatment for TB
received RTV+d4T+3TC. Standard treatment for TB in South Africa is rifampin,
isoniazid (x 6 months) and pyrazinamide (x initial 2 months only). The
probability of achieving a viral load <400 copies/mL by 9 months post-ART
initiation among those surviving was calculated by Kaplan-Meier methods.
Results: Initiating ART were
254 HIV-infected children (median age 9 months, 80% WHO stage III/IV, median
CD4 19%). At the time of starting ART, 20% were receiving co-treatment for TB
and over the following 9 months, another 18% of children on ART initiated TB
treatment. Overall mortality at 9 months was 12.6% and 84% of surviving
children achieved HIV RNA <400 copies/mL at 9 mos. Children on TB treatment
at ART initiation were less likely to suppress by 9 months (78.3% suppressed)
than children never co-treated for TB (94.1% suppressed). Children who
initiated TB treatment after ART initiation had the lowest suppression rates
(54.3% suppressed). Low weight-for-age and height- for- age z-scores, higher
pre-ART viral load and lower CD4 percentage at ART were each associated with
significantly reduced likelihood of suppression. Younger age, although
associated with increased mortality, was not associated with reduced likelihood
of viral suppression.
Conclusions: High rates
of virological suppression can be achieved among children <2 years of age
initiating PI-based ART. However, co-treatment for TB, which in this case
included substitution of RTV for LPV/r, appears to adversely influence
suppression rates. How best to treat HIV-infected children who require TB
treatment needs further investigation.
|
