[30] PATTERN AND CORRELATES OF VIRAL LOAD IN KENYAN HIV-1 INFECTED CHILDREN

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] PATTERN AND CORRELATES OF VIRAL LOAD IN KENYAN HIV-1 INFECTED CHILDREN

[AUTHOR(S):] E Obimbo¹, D Mbori-Ngacha¹, P Otieno², A Isavwa¹, D Wamalwa¹, C Farquhar³, R Bosire¹, B Lohman^1,3, B Richardson³ and G John-Stewart^1,3
¹University of Nairobi, Nairobi, Kenya; ²Kenya Medical Research Institute, Nairobi, Kenya; and ³University of Washington, Seattle, USA

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 30
Antiviral Therapy 2003; 8(Suppl. 1):S191

[ABSTRACT:] Purpose: Levels of HIV-1 RNA considered indicative of increased risk for disease progression are not well defined for African children. We conducted a prospective observational study among Kenyan HIV-1 infected children to determine pattern and correlates of viral load (VL), and association with disease progression.

Methods: Infants in a perinatal cohort identified to be HIV-1 infected by DNA PCR were followed monthly to 1 year, then quarterly to 2 years or death. HIV- 1 RNA plasma VL and T lymphocyte subsets were determined at regular intervals.

Results: Among 62 HIV-1 infected infants, 56 infants were HIV-1 infected by age 1 month, median peak VL was 6.75 log (range 5.21–8.43), median VL set point was 6.1 log (range 4.31–7.95), and median decline from peak to set point was 0.71 log (range 0.02–3.24). In three infants, all infected by 1 month, VL peaked >6 months after infection. Thirty-two infants (52%) died during follow up at a median age of 6.2 months. Correlates of peak VL included high maternal VL (HR=6.3, P=.001), premature birth (HR=2.0, P=0.050), infant CD4 <15% by age 6 months (HR=11.1, P=0.033) and infant CD4 count <200 by age 6 months (HR=10.0, P=0.018). Decline of VL of >2 log was associated with reduced mortality (HR=0.06, P=0.048). There was a trend for association between peak VL and VL set point (HR=2.0, P=0.1).

Conclusions: High peak VL is associated with high maternal VL, premature birth, high VL set point and with rapid disease progression among Kenyan HIV-1 infected infants.

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