|
Impact of highly active antiretroviral therapy on the incidence of HIV-encephalopathy among perinatally-infected children and adolescents
Presented by Kunjal Patel, United States.
K. Patel1, S.X. Ming2, P.L. Williams3, K.R. Robertson4, J.M. Oleske5, G.R. Seage III1, International Maternal Pediatric Adolescent AIDS Clinical Trials 219/219C Study Team
1Harvard School of Public Health, Center for Biostatistics in AIDS Research, Department of Epidemiology, Boston, United States, 2New Jersey Medical School, Department of Neurology and Neurosciences, Newark, United States, 3Harvard School of Public Health, Center for Biostatistics in AIDS Research, Department of Biostatistics, Boston, United States, 4University of North Carolina at Chapel Hill, Department of Neurology, Chapel Hill, United States, 5New Jersey Medical School, Department of Pediatrics, Newark, United States
Background: Prior to the development of antiretroviral treatment, the clinical course of pediatric HIV infection was frequently associated with HIV-encephalopathy, resulting in debilitating morbidity and early mortality. With the development of highly active antiretroviral therapy (HAART) there is a need to quantify the impact of HAART on the incidence of HIV encephalopathy among perinatally-HIV-infected children.
Methods: 2351 children and adolescents perinatally infected with HIV who were enrolled and had at least one neurological exam in a US-based multicenter prospective cohort study (International Maternal Pediatric Adolescent AIDS Clinical Trials Group 219/219C) and who had not yet developed HIV-encephalopathy prior to or at baseline were followed for incident HIV-encephalopathy between 1993-2007, which includes the pre-HAART and HAART era. A Cox regression model was used to estimate the effects of HAART and other sociodemographic and clinical variables on HIV-encephalopathy.
Results: By the end of follow-up there were 98 cases of HIV-encephalopathy with an incidence rate of 6.3 cases per 1000 person-years. The median age at diagnosis was 6.4 years and the median survival after diagnosis was 3.2 years. Younger age at baseline, CDC clinical classification C disease at baseline, and low CD4% at baseline were associated with an increased risk of HIV-encephalopathy. Low birthweight was also associated with an increased risk of HIV-encephalopathy. In contrast, use of HAART regimens at baseline was associated with a 63% (95% confidence interval: 27-81%) decrease in the incidence of HIV-encephalopathy compared to use of non HAART regimens.
Conclusions: Low birthweight, severe clinical disease and immunosuppression increased the risk of HIV-encephalopathy. The use of HAART is highly effective in reducing the incidence of HIV-encephalopathy among children and adolescents infected with HIV.
|