17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

IMPACT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ON THE INCIDENCE OF HIV-ENCEPHALOPATHY AMONG PERINATALLY-INFECTED CHILDREN AND ADOLESCENTS

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0103

K. Patel¹, S.X. Ming², P.L. Williams³, K.R. Robertson⁴, J.M. Oleske⁵, G.R. Seage III¹, International Maternal Pediatric Adolescent AIDS Clinical Trials 219/219C Study Team
¹Harvard School of Public Health, Center for Biostatistics in AIDS Research, Department of Epidemiology, Boston, United States, ²New Jersey Medical School, Department of Neurology and Neurosciences, Newark, United States, ³Harvard School of Public Health, Center for Biostatistics in AIDS Research, Department of Biostatistics, Boston, United States, ⁴University of North Carolina at Chapel Hill, Department of Neurology, Chapel Hill, United States, ⁵New Jersey Medical School, Department of Pediatrics, Newark, United States

BACKGROUND: Prior to the development of antiretroviral treatment, the clinical course of pediatric HIV infection was frequently associated with HIV-encephalopathy, resulting in debilitating morbidity and early mortality. With the development of highly active antiretroviral therapy (HAART) there is a need to quantify the impact of HAART on the incidence of HIV encephalopathy among perinatally-HIV-infected children.

METHODS: 2351 children and adolescents perinatally infected with HIV who were enrolled and had at least one neurological exam in a US-based multicenter prospective cohort study (International Maternal Pediatric Adolescent AIDS Clinical Trials Group 219/219C) and who had not yet developed HIV-encephalopathy prior to or at baseline were followed for incident HIV-encephalopathy between 1993-2007, which includes the pre-HAART and HAART era. A Cox regression model was used to estimate the effects of HAART and other sociodemographic and clinical variables on HIV-encephalopathy.

RESULTS: By the end of follow-up there were 98 cases of HIV-encephalopathy with an incidence rate of 6.3 cases per 1000 person-years. The median age at diagnosis was 6.4 years and the median survival after diagnosis was 3.2 years. Younger age at baseline, CDC clinical classification C disease at baseline, and low CD4% at baseline were associated with an increased risk of HIV-encephalopathy. Low birthweight was also associated with an increased risk of HIV-encephalopathy. In contrast, use of HAART regimens at baseline was associated with a 63% (95% confidence interval: 27-81%) decrease in the incidence of HIV-encephalopathy compared to use of non HAART regimens.

CONCLUSIONS: Low birthweight, severe clinical disease and immunosuppression increased the risk of HIV-encephalopathy. The use of HAART is highly effective in reducing the incidence of HIV-encephalopathy among children and adolescents infected with HIV.

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2008-08-13
MOAB0103

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