Publications

24

Jun, 2017

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents – a multiregion analysis from Southern Africa, West Africa, and Europe

 

Authors: Schomaker M, Leroy V, Wolfs T, et al. On behalf of theIeDEA West and Southern Africa regional collaborations and COHERE in EuroCoord.

Published in: Int J Epidemiol. 2017;46(2):453-465.

Background: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.

Methods: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula.

Results: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm3(394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes.

Conclusions: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.

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21

Jun, 2017

9th International Workshop on HIV Pediatrics, Paris 21-22 July 2017

 

The International Workshop on HIV Pediatrics is the only conference focusing on HIV Pediatrics on an international level. By registerlogo-ped-2017ing and joining, you get access to a highly interactive and informal setting where you will have the opportunity to interact with experts from the various disciplines involved with daily clinical care for infants and children. The 2-day program will include invited lectures, abstract-driven presentations, panel debates and roundtable discussions. This will be your opportunity to present, discuss, review and evaluate the latest developments.

 

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20

Jun, 2017

Tr@inforPedHIV 2017 edition: enrollment is now closed

Tags: , ,

The enrollment to the Tr@inforPedHIV 2017 edition has closed today.

Keep an eye on the Tr@inforPedHIV page on this website to find out how and when to enroll in 2018 edition.

 

18

Jun, 2017

Chronic Hepatites C in children in the Russian federation: a multicenter study

 

Authors: Volynets G, Skyortsowa TA, Ptapov AS, et al.

Published in: EASL, 19th – 23rd April 2017, Amsterdam

 

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18

Jun, 2017

Co-infection with HIV and HCV in 229 children and young adults living in Europe

 

Authors: Thorne C, Turkova A, Indolfi G, Venturini E, Giaquinto C

Published in: AIDS. 2017;31(1):127-135.

Objective To characterize children, adolescents and young adults infected with HIV/hepatitis C virus (HCV) vertically or before age of 18 years and living in Europe regarding mode of acquisition, HCV genotype, clinical status and treatment.

Design Retrospective, cross-sectional study using pooled data from 11 European paediatric HIV cohorts.

Methods Patients aged more than 18 months and less than 25 years, with HIV/HCV acquired vertically or in childhood, were included. Anonymized individual patient data were collected using a standard protocol and modified HIV Cohorts Data Exchange Protocol.

Results Of 229 patients included, 142 (62%) had vertically acquired infection. Median age at last follow-up was 16.2 years. Most children had HCV genotype 1 (101/184, 55%) or 3 (57/184, 31%). One-fifth (46/214) had a previous AIDS diagnosis (data missing on prior AIDS diagnoses for 15). At their last clinic visit, 70% (145/208) had no/mild immunosuppression (Centers for Disease Control and Prevention stage 1), and 131 of 179 on antiretroviral therapy had undetectable HIV RNA (assay thresholds varied from <20 to <150 copies/ml). Overall, 42% (86/204) had hepatomegaly in the previous year, and 55% (116/213) had alanine aminotransferase more than 40 IU/l at their last test. Of 97 patients with transient elastography, 12 had results more than 9 kPa; this was associated with duration of HCV infection (P = 0.033), but not with CD4 cell count, antiretroviral therapy use or sex in univariable analysis. Of 17 patients with liver biopsies, six had bridging fibrosis and one had cirrhosis. Twenty-five (11%) had been treated successfully for HCV.

Conclusion The high proportion of patients with progressive liver disease underscores the need for close monitoring and earlier and more effective HCV treatment.

18

Jun, 2017

Hepatitis C Co-Infection and CD4+ T Cell Recovery in HIV-Infected Children Receiving Anti-Retroviral Therapy.

 

Authors: Majekodunmi AO, Thorne C, Malyuta R, et al.

Published in: Pediatr Infect Dis J. 2017;36(5):e123-e129

Background The effect of hepatitis C virus (HCV) coinfection on CD4 T cell recovery in treated HIV-infected children is poorly understood.

Objective To compare CD4 T cell recovery in HIV/HCV coinfected children with recovery in HIV monoinfected children.

Method We studied 355 HIV monoinfected and 46 HIV/HCV coinfected children receiving antiretroviral therapy (ART) during a median follow-up period of 4.2 years (interquartile range: 2.7-5.3 years). Our dataset came from the Ukraine pediatric HIV Cohort and the HIV/HCV coinfection study within the European Pregnancy and Paediatric HIV Cohort Collaboration. We fitted an asymptotic nonlinear mixed-effects model of CD4 T cell reconstitution to age-standardized CD4 counts in all 401 children and investigated factors predicting the speed and extent of recovery.

Results We found no significant impact of HCV coinfection on either pre-ART or long-term age-adjusted CD4 counts (z scores). However, the rate of increase in CD4 z score was slower in HIV/HCV coinfected children when compared with their monoinfected counterparts (P < 0.001). Both monoinfected and coinfected children starting ART at younger ages had higher pre-ART (P < 0.001) and long-term (P < 0.001) CD4 z scores than those who started when they were older.

Conclusions HIV/HCV coinfected children receiving ART had slower CD4 T cell recovery than HIV monoinfected children. HIV/HCV coinfection had no impact on pre-ART or long-term CD4 z scores. Early treatment of HIV/HCV coinfected children with ART should be encouraged.

1

Jun, 2017

The Challenge of Treating Children with Hepatitis C Virus Infection

 

Authors: Indolfi G, Thorne C, El-Sayed MH, Giaquinto C, Gonzalez-Peralta RP.

Published in: J Pediatr Gastroenterol Nutr. 2017;64(6):851-854

Abstract The development of oral hepatitis C virus (HCV) direct-acting antivirals (DAAs) has revolutionized the therapeutic field. Nowadays, multiple safe and highly effective antiviral regimens are commercially available to treat adults with hepatitis C infection. These new regimens for the first time genuinely raise the prospects of eradicating HCV. Many challenges, however, remain from identifying infected individuals to optimizing treatment and ensuring global access to antiviral therapy to all population groups, including children.

 

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