final program.qxd - Parallels Plesk Panel

OP 2.4
Research Priorities in HIV/In Therapy
No abstract available
OP 3.1
The outcome of Children HIV - Infected at the beginning of the epidemics
Dr Albert Faye, Service de Pédiatrie Générale de l'Hôpital Robert Debré, Paris, France
Very long term outcome of HIV-1 infected children is one of the major issue of pediatric
AIDS epidemics. The positive impact of HAART and particularly of the early treatment in
HIV infected infants has been demonstrated now in several observational studies.
However this impact is counterbalanced by the potential long term side effects of the
antiretroviral drugs. Lipodystrophy, and metabolic abnormalities such as high lipids and
insulin levels has been described respectively in 24 and 42% of a longitudinal French
cohort. Other metabolic abnormalities such as bone disorders with tenofovir and
mitochondiopathy with nucleoside inhibitors are also of great concern in children. The
virus itself could be also involved in long term cardiovascular complications in
HIV-infected children with or without HAART.
ABSTRACTS
Few clinical and biological data are available for adolescents living with HIV infection since
birth. Analysis of the subgroup of children and adolescents, still alive, born before 1993
and whose most recent medical visit took place after 2002 was done in the French
prospective perinatal cohort. Of the 592 infected children followed since birth, 171 (92
boys and 79 girls), met the criteria for this analysis, with a median age at last visit of 14.5
years (IQ: 13.0 ; 16.5 years). A history of CDC category C diagnosis was reported for 19%
of the children. Most (92%) were initially treated with Zidovudine monotherapy.
Subsequently, and at various ages, 87% of children received HAART (36% between the
ages of 3 and 6 years). At last visit, 77% were receiving multitherapy, 19% received no
ART and 4% were maintained on bitherapy. Sixty percent of the current HAART consisted
of a combination of nucleoside analogs with boosted proteases inhibitors. The median
CD4 T-cell percentage was 30% at first ART. It was 27% at last visit, with a minority of
children having CD4 percentage below 15 (15%). The last median CD4 cell count was
565/mm3. The last median viral load (VL) was 170 copies/mL. VL was below 400 cp/mL
for 54 % of children, and over 100,000 cp/mL for 7% only. Thus, despite a long period of
suboptimal antiretroviral treatment, most of the still alive young adolescents currently are
in a good clinical, immunological and virological state.
Finally, asymptomatic long term survivors (ALTS) are very few in children representing
around 3% in the French Perinatal cohort after 12 years of follow up. These ALTS children
have received either no antiretroviral drug or a monotherapy and have CD4 cell counts
more than 15%. Understanding the mechanisms of such clinical and biological outcome
is an important challenge in the long term pediatric HIV infection management.
“ Focusing FIRST on PEOPLE “ 39 w w w . i s h e i d . c o m