Akao, K

Gupta, Jitendra

Janssens, Bart

Khem, S

Nerrienet, E

Raleigh, B

Soeung, S

Te, V

Zachariah, R

English

MSF Field Research

Excellent outcomes can be achieved in children on HAART under routine program conditions in Cambodia.
Experience from two hospitals in Siem Reap and Takeo, Cambodia.
Raleigh B.1, Soeung S.2, Akao K.2, Te V.3, Gupta J.1, Khem S.1, Janssens B.1, Nerrienet E.4, Zachariah R.5
1Medecins sans Frontières, Cambodia, 2Angkor Hospital for Children, Siem Reap, Cambodia, 3Takeo Provincial Hospital, Cambodia, 4Institut Pasteur du Cambodge, 
5Medecins sans Frontières, Operational Centre Brussels, Belgium.
 In 2005, 2.3 million children under 15 were estimated to be living with HIV/AIDS. 
 Cambodia is ranked 130th on the human development index with an annual GDP per 
capita of $ 2,078. 
 HIV prevalence in Cambodia fell from 3% in 1997 to 1.9 % in 2003.
 In Cambodia antiretroviral therapy has been provided since 2001 and by December 
2005, government and non-government actors were supporting around 12,000 
patients with HAART.
 HIV care and HAART has been offered to children in the provincial towns of Siem 
Reap and Takeo with the assistance of Médecins San Frontières (MSF) since 2002. 
Introduction
Introduction
Methods
• Analysis of cumulative data gathered between 2002 and March 2006 using the FUCHIA monitoring software (Epicentre-MSF). 
• Cross-sectional evaluation of viral load for all children 13 years of age or less and on HAART for 1 year or more was performed between February 
2006 and April 2006. HIV-1 RNA viral load was quantified by real-time RT-PCR assay using the HIV generic kit as developed by the French Agence
National de Recherche sur le SIDA (ANRS).  
• For all children with detectable viral load (defined as > 400 or > 2.6 log10 copies/ml), a genotype resistance test for RT regions was performed.
Results
3) Results of cross-sectional viral load evaluation at 12 months of HAART.
4) Results of genotype analysis of patients with detectable viral load.
1) Characteristics of the study population.
Discussion
• 193 samples were obtained.
• 156 (81%) had an undetectable viral load, 30 (15.5%) had  a viral load above 
1000 cps/mm³.
• In an intention to treat analysis, the 74% of patients that started HAART had 
an undetectable viral load.
• 21/30 patients with a VL > 1000cps/ml also showed immunological failure 
(WHO criteria).
• Good outcomes can be achieved among children offered HAART using a first line regime of lamivudine, stavudine and nevirapine in the form of 
adult, fixed-dose, generic combinations under routine programme conditions in Cambodia. (Even though this population had severe immune 
depression at the commencement of treatment.)
• Results achieved are comparable to those for children receiving treatment in resource-rich settings and at least as good as those for resource-
poor settings.  Our experience gives strong support to actively include children within the scaling-up process in the country. 
• This analysis of viral load and resistance genotype shows the urgency to adopt strategies that allow early detection of treatment failure and the 
switch of treatment to an effective second line regimen in paediatric cohorts.
• At least 7 children with treatment failure were non-naïve. We are not certain about previous ARV use for patients, so it is difficult to analyse the 
success rate of treatment for treatment naïve patients. 
• Polymerase chain reaction (PCR) tests for the early diagnosis of HIV in children under 18 months of age need to be made available wherever there 
are paediatric HAART programmes, to facilitate access of this group to treatment.
XVI IAS AIDS conference, Toronto 2006. Poster code: MOPE0254
Objective
Evaluate the immunological and virological outcomes of a paediatric HAART cohort at 12 months of HAART
• 32 genotype results were obtained for 37 
patients with a detectable VL.
• 3 patients showed no mutations, all of them 
had a VL between 400 and 1000 cps/ml. All 
patients with VL > 1000 cp/ml had at least one 
mutation (n = 29) .
• 27/29 patients showed an NRTI mutation, 
mostly M184 (n=24), D67 (n=7), T215 (n=6), 
T69 and L210 (n=4).  27 patients had 
developed resistance to 3TC, 
8 to AZT and 9 to d4T. Resistance to ABC was 
found in 5 patients, to TDF in 3 patients, and 
to ddI in 3 patients. 
• 27/29 had developed NNRTI resistance.
RNA-HIV1 viral load Number of patients (%) 
< 400 copies/ ml 156 (81%)
400 – 1000 copies/ ml 7 (3.6%)
1000 – 30000 copies/ ml 9 (4.6%)
> 30000 copies/ ml  21 (10.8%)
• 428 children started HAART between June 2003 and March 2006, 212 patients 
started HAART before March 2005 and are included in the analysis.
• 153 (72%) were treated in Siem Reap, 59 (28%) in Takeo 
• Median age was 6 years (IQR 4.2- 7.9), 94 (44.4%)  female, 73 (35%)  
orphans.
• Median CD4% before the start of HAART was 6% (IQR 2.6%- 13%).
• CDC stages N, A, B and C were 11%, 26%, 44%, and 19% respectively.
2) Treatment outcomes for patients starting HAART before March 2005. 
• 13 patients died, 4 were lost to follow up and 2 were transferred to another 
service. 
• 193 alive on HAART, median time on HAART is 16.8 months (IQR 13.9- 21.2)
• The median CD4 % at 12 months of HAART was 25%.
• Survival at 12 months of HAART is 92%
• Only 1 patient had started 2nd line HAART
Survival Function
30 20 10 0
1.00
.95
.90
.85
.80
.75
.70
C
u
m
 
S
u
r
v
i
v
a
l
Time (months)
Group
1.00
1.00-censored
28
5
12
3
31 32
3
11
0
5
10
15
20
25
30
35
3TC ABC D4T DDI EFV NVP TDF ZDV
NRTI              NNRTI
ARV Resistance
77 8
5 6
3 2
4
1
24
5
2
6
4
6
1
20
2 11 1 11 2 0
5
10
15
20
25
30
A
6
2
D
6
7
D
6
9
E
4
4
F
1
6
G
1
9
0
K
1
0
1
K
1
0
3
K
2
1
9
K
6
5
K
7
0
L
2
1
0
L
7
4
M
1
8
4
M
2
3
0
M
4
1
L
Q
1
5
1
T
2
1
5
T
6
9
V
1
0
6
V
7
5
Y
1
1
Y
1
8
1
Y
1
8
8
Resistance Mutations
7 7

Excellent outcomes can be achieved in children on HAART under routine program conditions in Cambodia. Experience from two hospitals in Siem Reap and Takeo, Cambodia

Excellent outcomes can be achieved in children on HAART under routine program conditions in Cambodia. Experience from two hospitals in Siem Reap and Takeo, Cambodia

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