The 9th International Workshop on Pediatrics was held in Paris, France on the 21–22
July, 2017. It was co-chaired by Lynne Mofenson (EGPAF, USA), Albert Faye (University
Paris Diderot, Paris, France) and Valériane Leroy (INSERM, France). Over 300 participants
attended the workshop. The abstracts included 20 oral presentations, 87 posters and
45 abstract book-only abstracts. (Workshop materials such as abstracts and presentations
can be found at:
www.infectiousdiseasesonline.com).
Session 1: Pediatric treatment and management
Pediatric HIV in Eastern Europe, PMCT in an urban area in the US, digital technology
and adherence, and a single-tablet regimen for the under 12s
Natella Rakhmanina
Children's National Medical Center, EGPAF, USA
Natella Rakhmanina gave an overview of the current status of the HIV epidemic in Eastern
Europe. Independent of varying definitions of the Eastern European region, most of
the HIV epidemic is concentrated in Russia and Ukraine, accounting for the estimated
85–90% of people living with HIV in the region [1,2] (Figure 1). Throughout the last
decade, the epidemic has continued to rise with Eastern Europe mostly contributing
to the unprecedented high number of 153,403 new HIV infections within European Region
in 2016 [1,2]. The three biggest challenges facing the region are: the increasing
number of heterosexual transmissions in women of childbearing age, which overtook
injecting drug use transmissions in males; the high number of people living with HIV
who remain undiagnosed; and low antiretroviral treatment (ART) coverage among people
living with HIV.
Figure 1.
HIV in Eastern Europe, 2015
Despite the overall growth of HIV epidemic during last decade, Eastern Europe has
witnessed a steady decline in the rates of mother-to-child transmission (MTCT) of
HIV, with Belarus and Armenia reaching the WHO elimination target in 2016 of fewer
than 50 HIV infections per 100,000 live births. Even in Russia and Ukraine, MTCT national
rates have remained below 2% [1-3]. With the current rise in heterosexual transmission
in the region, however, women of childbearing age are progressively making up an increasing
proportion of people living with HIV. Maintaining focus on targeted repeat HIV testing
and prevention of MTCT, including implementation of PrEP in pregnancy and the postpartum
period for women with high-risk partners, is required to avert the potential rise
in MTCT in Eastern Europe.
Adolescents and youths aged 15–24 years accounted for less than 10% of all new cases
in Eastern Europe in 2015; however, the actual epidemic within this age cohort is
most likely to be underestimated [2]. The young people of the region have multiple
risk factors for HIV including a lower age for becoming sexually active, exposure
to alcohol and drugs, gender inequality and gender-based violence, labour migration,
displacement, human trafficking, marginalisation and sexual exploitation [1,2,4].
Among those living with HIV, perinatally infected adolescents and youth frequently
lack family support and have history of institutional care placement [4]. Horizontally
infected youth are diagnosed late and frequently face substance abuse with limited
harm reduction and treatment options [4]. The scope of the epidemic amongst young
men who have sex with men (MSM) remains largely unknown except in a few countries
[1,2,4]. Finally, limited data on engagement in care and transition suggest high rates
of loss to follow up [4]. Overall, better data on adolescents living with HIV including
marginalised and young MSM populations are urgently needed in Eastern Europe.
In a poster presentation, Ellenberger et al. evaluated approaches to and outcomes
of PMTCT during 2013–2015 in a high HIV prevalence metropolitan area in the USA [5].
In a retrospective cohort analysis of 279 HIV-exposed infants (HEIs), low MTCT risk
was observed among the majority (85%). Despite low risk and contrary to the national
neonatal prophylaxis guidelines, a significantly large proportion of mothers (72%)
received intravenous zidovudine (ZDV) and more than half (57%) had a Caesarean section.
Evaluation of indications for Caesarean section is ongoing to identify whether it
was based on MTCT risk assessment or obstetric/neonatal factors. Among high-risk HEIs
with a high risk for MTCT, a significant proportion (40%) of US-born infants received
postpartum mono-prophylaxis with ZDV, while 58% received dual or triple antiretroviral
drug combinations. No perinatal transmissions occurred within the studied cohort.
HIV-positive youth are known to be at high risk for poor adherence to ART. Digital
game-based interventions are promising, especially among adolescents. In this poster
presentation, Griffith et al. aimed to examine the uptake of interactive smartphone-based
games interlinked with a medication-monitoring device (Wisepill dispenser) among a
cohort of 24 (mean age=18 years; 12 males, 12 females) HIV-infected adolescents and
young adults (AYA) on ART [5]. Participants opened their Wisepill dispensers only
25% of the time based on the prescribed ART frequency of once per day (407 actual/1607
prescribed openings). Although a real-time, electronic ART adherence monitoring system
interlinked with smartphone gaming was clearly technically feasible, the authors reported
low uptake of this technology among the cohort of HIV-infected AYAs with documented
suboptimal ART adherence. Data from ongoing exit surveys will be used to modify gaming
and adherence monitoring design.
Currently, no once-daily single-tablet regimen (STR) is approved for use in HIV-infected
children under 12 years of age [6]. Elvitegravir/cobicistat/emtricitabine/tenofovir
alafenamide (EVG/COBI/FTC/TAF; E/C/F/TAF) is a once-daily integrase inhibitor (INSTI)-based
STR approved for use in adults and adolescents aged 12 years and over and weighing
at least 35 kg. In a poster presentation, Rakhmanina et al. reported safety and efficacy
data for using E/C/F/TAF in younger, virologically suppressed children (6–<12 years
of age and weighing ≥25 kg) through week 48. In 23 (median age 10 years, median weight
31 kg, 61% female, 78% black) HIV-infected children weighing at least 25 kg, the currently
available formulation of E/C/F/TAF was well tolerated and safe, reflected by sustained
virological suppression and a persistent favourable renal and bone safety profile
out to week 48. These findings support the safety and efficacy of E/C/F/TAF as the
first once-daily INSTI-based STR in children weighing ≥25 kg.