TREATMENT INTERRUPTION IN HIV INFECTED CHILDREN: A DESCRIPTIVE STUDY

Ariane Alimenti, Dominique Khoo, David Burdge, Jack Forbes
Oak Tree Clinic; Children’s and Women’s Health Centre of British Columbia; University of British Columbia, Vancouver, British Columbia

Background: Treatment interruption (TI) is an option for HIV+ adults with treatment failure/toxicity or low VL/high CD₄. Benefits may include reduced toxicity, reduced resistance. Little data exist on TI in children.
Objective: To describe clinical, immunologic, virologic and genotypic outcomes of vertically HIV-infected children interrupting therapy in our centre.
Method: Data collected included clinical/immunologic stage, reason/length of TI, clinical/CD₄/VL response on TI and after restarting therapy and genotyping results.
Results: Eleven patients (30% of patients on therapy) received TI (median age 6.7 y, range 3.8-12); all were CDC stage A-B/1-2. Median duration of ART was 4.5 y and of HAART (8/11 pts) was 2.5 y. Reasons for TI were: toxicity (4 patients), treatment failure (3), low VL/high CD₄ (3), parental decision (1). Median duration of TI was >6 months (1-15m). Median absolute (%) CD₄ decline from baseline of 1280/mm³ (39%) was 5/mm³(5%) at 1-2 months of TI (n=10), 80/mm³ (4%) at 3-4 months (n=8), 190/mm³ (5%) at 5-7 months (n=6). VL increased by a median of 1 log then remained stable. Genotyping showed loss of resistance during TI in 1 of 2 patients and was not possible prior to TI in 6/11 (low VL). TI resulted in resolution of toxic effects; appetite improved in most children and weight gain increased in 4/9 with >3 m observation. HAART was successfully resumed in 3 patients after marked CD₄ decline and/or VL increase.
Conclusions: TI may be an option for asymptomatic immuno-competent HIV infected children with ART toxicity/failure or low VL. We observed slow CD₄ decline and moderate VL increase, resolution of toxic effects, improved appetite/weight gain, family approval, favorable genotypic changes in one child and good subsequent response to HAART. Further studies of TI outcomes are needed on larger numbers of children.