P-A7 HIV disease history in perinatally HIV infected adolescents with interrupted care

Abstract

Early initiation of HAART preserves the robust immune system of perinatally HIV infected children and limits viral reservoir size. Our aim was to study the current immune and virological status of perinatally infected adolescents who returned after defaulting care. A retrospective analysis was conducted on laboratory outcomes stratified by defaulters and non-defaulters and among age bands at HAART commencement. Among 78 patients, the median age was 14 years [IQR 13,17]. HAART was commenced at a median age of 6 years [IQR 3,8] with 45 (57%) at >6 years. Among 27 defaulters the median time of default was 22 months. Total time on HAART was a mean of 8.5 years ± 3 years and 56 (71%) were on protease inhibitors. Zenith HIV RNA load was a median of 4.8 log10 copies/ml [IQR 4.2–5.2]. Nadir CD4 cell count was 368 [IQR 61,648]. Median current CD4 percent was 33.5% [IQR 18,46] Duration of CD4 of 15-25% was 12 months [IQR 4, 32] for defaulters compared with 4 months [IQR 0,8] for non-defaulters. The mean duration of viral load <500 copies/mL was 1.48 ± 1.68 years among defaulters, 3.6± 3.2 years among non defaulters (p < 0.0001); 3.9 ± 3 for those commencing HAART at age 1-5 years, and 2.4 ± 2.6 for >6 years (p < 0.05). Seventy percent of adolescents commencing HAART at 1-5 years versus 43% at age >6 year had a current CD4 count >500 (P < 0.03). Virologic suppression was 67% in the 1–5 year band versus 27% in the >6 year band (p < 0.0001). Defaulters and non defaulters did not differ with current virologic or immunologic markers. Late age at starting HAART had a greater negative influence on final outcome than interrupted therapy. These results suggest the potential in HIV remission research of interrupting HAART after early initiation of treatment.