MOAB01 - Clinical issues in HIV-infected children and those exposed to ARV in utero This session covered several important pediatric issues, the effect of in utero ARV exposure on neurodevelopment in HIV-exposed but uninfected children; the effect of HAART on CNS disease in HIV-infected children and viral and immune response to treatment in children in low resource countries.

MOAB0102 - Neurodevelopmental status and prenatal antiretroviral exposure in HIV-exposed, uninfected infants This study compared 1694 HIV-exposed to 146 unexposed children. Bayley Scales of Infant Development were used to evaluate the association of in utero ARV exposure on Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 2 years of age. MDI scores were higher for ARV-exposed than unexposed among children with low birth weight (LBW) (p=0.01). In this study, 17% of mothers self-reported antenatal substance use, but there was no association with MDI or PDI scores in this subgroup. There was a slight decreasing trend in scores with increasing maternal viral load, but no effect of maternal ART controlling for viral load. Overall this evaluation found similar cognitive and motor scores between children exposed in utero to ARVs vs unexposed, after adjustment for a large number of covariates.

MOAB0103 - Impact of highly active antiretroviral therapy on the incidence of HIV-encephalopathy among perinatally-infected children and adolescents There were 77 encephalopathy cases in this incidence analysis of 2,272 children and adolescents. 5.1 per 1000 patient years. Median age at diagnosis was 6.3 years. Risk factors were: younger age, CDC clinical classification C disease, and low CD4% at baseline. LBW was also associated with an increased risk of HIV-encephalopathy. Use of HAART regimens was associated with a 50% decreased risk compared with non-HAART regimens.

MOAB0104 - Virological suppression in children receiving ART in an urban South African setting Among 1179 children starting ART in this South African study, those not undetectable (viral load <25 copies/mL) by 6 months since treatment initiation were less likely to be undetectable at 18 months (p<0.0001) and by 24 months (p=0.0003). The effect was less by 36 months and 48 months. This association was greater for children <18 months versus >18 months. Undetectable rate at both 3 and 6 months was significantly lower (p<0.0001 and 0.0349 respectively) in children started on HAART before age 18 months. The investigators noted that the dynamics of starting treatment at different ages during childhood may vary.

 M0AB0105 - Once a day paediatric HAART with ddI+3TC+EFV in Burkina Faso – a phase II trial (ANRS 12103 trial) This trial looks at pharmacokinetics, tolerability and adherence of a once-a-day paediatric 3TC + ddI + EFV in naïve children in Burkina Faso. Twelve month preliminary data from 50 children suggest that once-a-day 3TC + ddI + EFV in children provides satisfactory plasma concentration for EFV and ddI, and is associated with virological suppression (39/49, 80% <300 copies/mL) and immune reconstitution. Seven children with viral load >1000 copies/mL had detectable resistance. All achieved virological suppression with second line therapy.