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High survival and treatment success sustained after up to three years of ART for children in Cambodia
Presented by Petros Isaakidis (Cambodia).
P. Isaakidis1, M.-E. Raguenaud1, V. Te2, C.S. Tray3, K. Akao3, V. Kumar3, S. Ngin4, E. Nerrienet4, R. Zachariah5
1Medecins Sans Frontieres, Phnom Penh, Cambodia, 2Donkeo Referral Hospital, Ministry of Health, Pediatrics Department, Takeo, Cambodia, 3Angkor Hospital for Children, Siem Reap, Cambodia, 4Pasteur Institute, HIV/Hepatitis Laboratory, Phnom Penh, Cambodia, 5Medecins Sans Frontieres, Brussels, Belgium
Background: Long-term outcomes of antiretroviral therapy (ART) in children remain poorly documented in resource-limited settings.We assessed three year survival, CD4-evolution and virological response among children enrolled in a programmatic setting in Cambodia.
Methods: Cross-sectional survey within a cohort study. Two pediatric HIV-clinics delivered ART since 2003. Children treated with first-line ART for at least 24 months were assessed with viral load and genotyping. Kaplan-Meier method and Cox regression were used to assess survival and risk factors for treatment failure.
Results: Of 1168 HIV+ children registered, 670 (57%) started ART between January 2003 and December 2007. Survival probability was 0.95 (95%CI:0.93-0.97), 0.93 (95%CI:0.91-0.95) and 0.91 (95%CI:0.88-0.93) at 12, 24 and 36 months respectively. Among 270 eligible children, 268 were assessed for viral load.128(48%) were female. Median age was 6 years. Median ART duration was 36.2 months (IQR:30.7-40.7).
Median CD4 gain for children over 5 years was +304, +704 and +737 cells/ml at 6, 24 and 36 months respectively, while for children under 5 years median CD4% gain was +10.0%, +15.2% and +15.0% at 6, 24 and 36 months.
In an intention-to-treat analysis, treatment success ratio was 85%. Among 138 patients who were at least 36 months on ART, 129(93.5%) had undetectable viral load. 22 children had VL>1,000copies/ml and 21/21 presented mutations conferring resistance mostly to lamivudine and NNRTIs.
CD4-count below threshold for severe immunosupression at month 24 and 36 predicted failure after month 24 and month 36 respectively .Only 2 out of 22 children with VL>1,000copies/ml met the WHO immunological criteria for failure (Sensitivity=0.1). Orphan status did not predict failure.
Conclusions: Good survival rate, immunological restoration and viral suppression can be achieved and sustained after three years of ART among children in resource-constrained settings. Increased access to routine virological measurements is needed in these settings to allow for timely and accurate diagnosis of treatment failure.
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