BHIVA: Improvements in response to HAART amongst children in UK and Ireland

Doctors in the United Kingdom and Ireland are becoming increasingly skilled at treating HIV infection in children and adolescents, according to data presented to the Twelfth Annual Conference of the British HIV Association in Brighton on March 30^th. The investigators told the conference that between 1996 and 2005, mortality and the number of children progressing to AIDS fell, whilst the proportion of children with durable virological suppression increased. Nevertheless, the researchers noted that a significant number of children have extensive experience of anti-HIV treatment and limited future treatment options.

Potent anti-HIV therapy has been used in children and adolescents since the mid 1990s, but less is known about their use in children than in adults. Investigators from the National Study of HIV in Pregnancy and Childhood and Collaborative HIV Paediatric Study (CHIPS) wished to describe changes in AIDS events and mortality, the response to antiretroviral therapy, and treatment experience in children in the UK and Ireland between 1996 and 2005.

Information was available for 354 children in 1996, increasing to 614 in 2000, and to 961 in 2005. Over half (55%) were born in the UK or Ireland, but only 20% were diagnosed at delivery, with 29% being aged five or over when their HIV was first diagnosed.

There was a steady decline over the nine years of the study in the proportion of children who progressed to AIDS and death. Before 1997, the rate of progression was 14 per 100 patient years of follow-up, this fell to 4 per 100 patient years in 2000/2001 and to 3 per 1000 patient years in 2004/2005. The investigators provided details of the 18 deaths that occurred between 2003 and 2005. Seven of these children already had AIDS when they first presented to HIV services and died within a month of HIV being diagnosed. Of the remaining eleven children, only three took more than six months of antiretroviral therapy prior to death.

Response to antiretroviral therapy improved during the period of the study. In 2000, only a third of children had an undetectable viral load (below 50 copies/ml) six months after starting antiretroviral therapy, but by 2004/2005 this had almost doubled to 64% with 76% of children taking antiretroviral having a viral load below 400 copies/ml.

However, the investigators noted that HIV-positive children in the UK and Ireland were becoming increasingly treatment-experienced. In 2004/2005, 33% of 10 - 14 year-olds and 41% of those aged over 14 had taken drugs from the three main classes of antiretrovirals.

“Morbidity and mortality rates have continued to decline in HIV infected children since the introduction of HAART in 1997”, conclude the investigators, however although “short-term HAART response is improving…longer-term clinical management is complex.”