231 Lopinavir/ritonavir-based Second Line Antiretroviral Treatment in children at National Pediatric Hospital, Phnom Penh, Cambodia

Abstract

Background and Objectives: Cambodia has scaling up a large national ART program using 1st line therapy (d4T or AZT+3TC+NVP or EFV). As March 31st 2008, 2689 HIV infected children were on HAART in Cambodia. 1059 children were registered (664 on HAART) in Child Health Improvement Clinic (CHIC), an HIV outpatient clinic set up by the National Pediatric Hospital (NPH), with French Red Cross technical support. We evaluated the current pediatric cases with 2nd line regimen. Methods: Data and medical records from a retrospective cohort followed at CHIC to 31st March 2008 were analyzed. Patients meeting the Cambodian National Guidelines for the Use of Pediatric ART for treatment failure were evaluated. Treatment failure was confirmed based on clinical and immunological failure and/or virological failure. Plasma viral load has been assessed by HIV RNA real time PCR using 2nd generation ANRS Kit. Genotypic resistance results were done at Institute Pasteur according to ANRS algorithm (v.sep.07). Results: 29/612 patient (4.7%), 31% female, switched to 2nd line were enrolled in this study. Median age was 10.4 years (4.3-17.1). Median duration in the 1st line was 1.9 years (0.6-6.3). Median of CD4 percentage when switching to 2nd line was 5.0% and VL was 5.1Log (4.0-6.3) with +/− clinical failure. At switch, 22 patients were tested for HIV drug resistance for RT gene. The results revealed that 95.4% (21/22) children were resistance to NVP/EFV, 77.3% to AZT/d4T, 54.5% to ABC/ddI, and 9.1% to TD. Median time in the 2nd line was 0.9 years (0.2-2.5). 18 of 29 patients (62.1%) receive standard 2nd line regimen (ABC/ddI/LPV/r), 5 (17.2%) with 3TC/TDF/LPV/r) and 2 (6.9%) with 3TC/AZT/LPV/r). Median CD4 gain on 2nd line regimen were 11.5% (1-31%) at M6 (n = 22); 15% (0-27) at M12 (n = 11); 15.5% (10-26) at M18 (n = 6); 18% (16-25) at M24 (n = 3); and 17% at M30 (n = 1). Patients who achieved undetectable VL (VL<2.4Log) at M2 were 62.5% (n = 24); 84.2% at M6 (n = 19); 80% at M12 (n = 10), 75% at M18 (n = 4) and 100% at M24 (n = 2). Conclusion: We report here the first immunological and virological results of children on 2nd line of ART in Cambodian. This data confirm a strong efficacy of LPV/r-based 2nd line regimen and provide important information for appropriate and effective HAART in children.