Abstract 949
Poster Session IV, Tuesday, 5/4 (poster 110)
To document changes in a cohort of children with perinatally acquired HIV-1 infection following the introduction of routine HIV-1 RNA measurements, a retrospective review of records was made 2 years after introduction of this procedure. Data from 37 children were evaluated (age: mean 44, median 39, range 1 to 166 months). At the start and end of the interval the population had geometric mean viremias of 61,659 and 20,714 (p <0.02) HIV-1 RNA copies/ml and mean percent CD4 cells of 24.1% and 24.2%. The number of antiretroviral drugs on which patients were maintained increased significantly from 0.95 to 2.30 per patient (p < 0.001). Data were stratified on over-study changes in HIV-1 RNA (using a previously determined significant change threshold +- 0.52 log 10 HIV-1 RNA copies/ml) into stable, progressing and regressing viremia groups. The stable group (22 patients) had HIV-1 RNA levels throughout the study of ∼ 40,000 HIV-1 copies/ml, stable percent CD4 (∼ 22%) and receive an average of 1.05 and 2.14 antiretroviral drugs at study entry and exit. The progressor (1 patient) had low HIV-1 RNA at entry (16,199) and high (822,621) at end and a substantial drop in percent CD4 (40% to 11%); he received 0 and 2 antiretroviral drugs at entry and exit. Notable features of the group with regressing viremia (14 patients) included a decrease in HIV-1 RNA from the highest group mean at the start (141,579) to the lowest (5,346) at the end and an increase in CD4 cells from 25% to 29%. Regressors averaged 0.86 and 2.57 antiretroviral drugs per patient at study entry and exit. Knowledge of HIV-1 level and use of newer antiretroviral drugs and combinations (in part driven by knowledge of HIV-1 level) together resulted in this population being virologically and immunologically stable or improved at 2 years from first HIV-1 load determinations. This is a substantially better course than that previously observed for this cohort. The duration of the benefit remains to be determined.
