ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

HIV in vulnerable populations. Co-morbidities in Children

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HIV in vulnerable populations and within a public health framework. 

 

Monday’s Plenary included a session on co-morbidities in children and adolescents by Thanyawee Puthanakit. 

 

She detailed some important paediatric aspects to HIV care. Eventually these children 'graduate' to adult services thus appreciating the unique commodities in this population is important to all providers of HIV care. 

 

In addition to the co-morbidities seen in an adult population, children living with HIV are more likely to have delayed puberty/growth, have persistent proteinuria and tubular dysfunction, have impaired peak bone mass and low bone mineral density and suffer dyslipidaemia. 

 

Not surprisingly, there is a significant reduction in the risk of developing co-morbidites when commenced on HAART. This echoes the findings of START which, while it did not focus on a paediatric population, demonstrated a clear benefit to early commencement of HAART.

 

Of note, dyslipidaemia occurred in  approximately 22% of children and adolescents with a lack of clinical trial data that demonstrated benefits from statin use. In any case, the threshold at which to treat an adolescent remains undefined. The rates of cardiomyopathy, nephropathy, cognitive impairment and chronic lung disease are all reduced in paediatric populations that are on HAART.

 

Paediatric guidelines for ART are evolving somewhat like adult guidelines. The DHHS recommends integrase-based regimens with Raltegravir approved for age >2 and Dolutegravir age>12. There is no evidence yet for the use of TAF in a paediatric population. 

 

The barriers to optimising outcomes within the paediatric population are more evident in resource limited settings, where children and adolescents are more likely to be under-screened for HIV co-morbidities.  

 

The speaker alluded to 2 trials of interest 

 

 

  1. ODYSSEY. Dolutergravir+2NRTIs vs standard of Care. This is an RCT of DTG based ART vs SOC in Children with HIV starting first line treatment or switching to second-line
  2. IMPAACT P1093: investigating Dolutegravir use in children aged 6-12
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