Paediatric ART: Successes and Challenges MOAB1
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Type:
Oral Abstract Session Back
Venue: Session Room 3
Time: 14:30 - 16:00, 20.07.2009
Code: MOAB1
Chairs: Glenda Gray, South Africa
Lynne M Mofenson, United States
Session recording provided by International AIDS Society



Presentations in this session:

14:30
MOAB101
Abstract
Powerpoint		Survival rates following expansion of the national pediatric antiretroviral treatment program, Thailand, 2000-2005
Presented by Michelle McConnell, Thailand
M. McConnell1, P. Yuktanont2, U. Siangphoe1, N. Pattarapayoon2, S. Kohreanudom2, R. Lolekha1, P.A. Mock1, S. Chasombat2, S. Thanprasertsuk3
1Thailand MOPH - U.S. CDC Collaboration, Nonthaburi, Thailand, 2Department of Disease Control, MOPH, Nonthaburi, Thailand, 3World Health Organization, Bangkok, Thailand

14:45
MOAB102
Abstract
Powerpoint		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

15:00
MOAB103
Abstract
Powerpoint		Randomized clinical trial of switching to nevirapine-based therapy for infected children exposed to nevirapine prophylaxis
Presented by Ashraf Coovadia, South Africa
A. Coovadia1, E. Abrams2, R. Strehlau1, L. Martens1, G. Sherman3, T. Meyers4, L. Kuhn5, NEVEREST Study Team
1University of the Witwatersrand, Coronation Hospital, Johannesburg, South Africa, 2Columbia University College of Physicians and Surgeons, Pediatrics, New York, United States, 3University of the Witwatersrand, Haematology, Johannesburg, South Africa, 4University of the Witwatersrand, Harriet Shezi Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa, 5Columbia University - Mailman School of Public Health, New York, United States

15:15
MOAB104
Abstract
Powerpoint		Virologic failure and second-line antiretroviral therapy (ART) in children in South Africa: the international epidemiologic databases to evaluate AIDS (IeDEA) Southern Africa collaboration
Presented by Mary-Ann Davies, South Africa
M.-A. Davies1, R. Wood2,3, G. Van Cutsem4,5, J. Giddy6, B. Eley7,8, H. Rabie9, H. Moultrie10,11, K. Technau10,12, A. Boulle1, International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA)
1University of Cape Town, Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, Cape Town, South Africa, 2University of Cape Town, Desmond Tutu HIV Centre, Institute for Infectious Diseases and Molecular Medicine, Cape Town, South Africa, 3Gugulethu Community Health Centre, Cape Town, South Africa, 4Medecins Sans Frontieres, Cape Town, South Africa, 5Khayelitsha Community Health Centre, Cape Town, South Africa, 6McCord Hospital, Durban, South Africa, 7University of Cape Town, School of Child and Adolescent Health, Cape Town, South Africa, 8Red Cross Children's Hospital, Cape Town, South Africa, 9University of Stellenbosch, Tygerberg Academic Hospital, Stellenbosch, South Africa, 10University of Witwatersrand, Paediatric HIV Clinics, Johannesburg, South Africa, 11Chris Hani Baragwanath Hospital, Harriet Shezi Clinic, Johannesburg, South Africa, 12Coronation Women and Children Hospital, Johannesburg, South Africa

15:30
MOAB105
Abstract
Powerpoint		How well do the revised World Health Organisation weight-based dosing guidelines for lopinavir/ritonavir in infants and children correlate with body surface area-based dosing recommendations?
Presented by James Nuttall, South Africa
J. Nuttall1, B. Eley1, M.-A. Davies2
1University of Cape Town, Paediatric Infectious Diseases Unit, Cape Town, South Africa, 2University of Cape Town, Infectious Diseases Epidemiology Unit, Cape Town, South Africa

Powerpoints presentations
Survival rates following expansion of the national pediatric antiretroviral treatment program, Thailand, 2000-2005 - McConnell

High survival and treatment success sustained after up to three years of ART for children in Cambodia - Isaakidis

Randomized clinical trial of switching to nevirapine-based therapy for infected children exposed to nevirapine prophylaxis - Coovadia

Virologic failure and second-line antiretroviral therapy (ART) in children in South Africa: the international epidemiologic databases to evaluate AIDS (IeDEA) Southern Africa collaboration - Davies

How well do the revised World Health Organisation weight-based dosing guidelines for lopinavir/ritonavir in infants and children correlate with body surface area-based dosing recommendations? - Nuttall



Rapporteur report

Track B report by Ian Frank, Pablo Tebas, Renslow Sherer and Roger Bedimo


Although vertically acquired HIV infection has almost disappeared in the developing world, it continues to be a very challenging problem in poorer countries. There are more than 2 millions infected with HIV and the number grows every year by more than 400,000.

The first presentation focused in the history and the outcomes of the Thai ART program started in the year 2002, with the introduction GPO-VIR (a fixed drug combination of D4T/3TC/nevirapine). They saw a very low mortality (5.2% per 100 PYFU) and a similar lost to follow up rate. Death was more frequent in children with more advanced disease and being taken care in regional and university hospitals (an unexpected finding). The second talk from Doctors without borders presented similar encouraging data from a cross sectional study in 2 clinics in Cambodia. The survival of the patients receiving ART at 2 years was 91%. The children that continued therapy had significant increases in CD4 cells and a majority had undetectable viral load. Failure was associated with low CD4 count.

Dr. Covadavia group from South Africa presented NEVEREST, a randomized trial of children that have been exposed to sdNVP at birth that were treated initially with a protease inhibitor based therapy (LPV/r) for a year and when undetectable randomized to continue it or switch to a nevirapine based regimen. Children randomized to switch to nevirapine were more likely to maintain a viral load less than 50 copies per ml, but also were more likely to have virologic failure over 1000 copies per ml. So although the primary endpoint result is encouraging, the outcomes are not completely reassuring

Davies et al looked at virologic failures in the South African pediatric program. The probability of virologic failure at 3 years was 11%. Less than half of children remaining in care for at least a year after virologic failure initiate second-line, probably as a result of a limited formulary. Children failing NNRTI-based regimens were more likely to be switched.

Nutall et al looked at the different effects on dosing LPV/r in children based on surface area or weight (a much simpler method) and demonstrated that dosing by weight tends to increase drug exposure, which seems like a good goal, but may be associated with increased toxicity.


   

   

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