St. George

1
Data from the Collaborative HIV Paediatric
Study (CHIPS) Reports up to March 2009
Numbers are based on reports received rather than
children seen to the end of March 2009. 2008/9
data are subject to reporting delay and may
therefore be incomplete.
2
Background to CHIPS

• The Collaborative HIV Paediatric Study (CHIPS)
  was established in April 2000 as a multi-centre
  cohort study of HIV-1 infected children in the UK
  and Ireland.
• The collaboration is between
• 63 clinics in the UK and Ireland that care for
  HIV-infected children, 16 of whom have 75
  children currently enrolled in PENTA trials
• the National Study of HIV in Pregnancy and
  Childhood (NSHPC), and
• the MRC Clinical Trials Unit

3
Follow-up status of 1560 children enrolled in
CHIPS
86 deaths prior to 2006, 4 in 2006, 3 in 2007,
8 in 2008
4
Age/year at first presentation to medical
services in the UK/Ireland (N1560)
Up to 2005 2006 2007
2008 Total At birth
133 (10) 7 (7) 6 (7) 5 (14)
151 (10) lt1 yrs 300 (22) 16
(16) 10 (12) 5 (14) 331 (21)
1-4 yrs 422 (32) 25 (25) 16 (19)
7 (20) 470 (30) 5-9 yrs 326
(24) 27 (27) 32 (37) 6 (17)
391 (25) gt10 yrs 158 (12) 25
(25) 22 (26) 12 (34) 217 (14)
Total 1339 (100) 100 (100)
86 (100) 35 (100) 1560 (100)
Includes all children (those still in follow-up
and those who have died, lost to follow-up, left
the UK Ireland or transferred to adult care)
5
Age distribution of children in follow-up by
year, 1996-2008
Year No. Median (IQR)
----------------- Age groups -----------------
age ? 1 yr 2-4 yrs
5-9 yrs 10-14 yrs ?15 yrs 1996 357
5.1 (2.9-7.6) 26(7) 146(41) 144(40)
40(11) 1(0) 1997 411 5.6
(3.1-8.3) 27(7) 151(37) 174(42) 55(13)
4(1) 1998 489 6 (3.3-8.9)
21(4) 169(35) 211(43) 78(16) 10(2)
1999 552 6.6 (3.7-9.8) 23(4) 170(31)
229(41) 112(20) 18(3) 2000 645
7.2 (4.1-10.5) 21(3) 188(29) 254(39)
143(22) 39(6) 2001 742 7.8
(4.7-11.1) 17(2) 193(26) 288(39) 197(27)
47(6) 2002 842 8.1 (5.1-11.7)
21(2) 180(21) 339(40) 236(28) 66(8)
2003 966 8.5 (5.7-12.1) 21(2) 178(18)
380(39) 300(31) 87(9) 2004 1059
9.2 (6-12.4) 19(2) 177(17) 404(38)
343(32) 116(11) 2005 1128 9.6
(6.6-12.9) 17(2) 147(13) 429(38) 390(35)
145(13) 2006 1185 10.3 (7-13.5)
14(1) 140(12) 412(35) 428(36) 191(16)
2007 1203 10.9 (7.6-14.1) 10(1) 126(10)
360(30) 484(40) 223(19) 2008 1130
11.2 (7.9-14.4) 11(1) 107(9) 320(28)
461(41) 231(20)
Age is taken to be age at start of the year, or
age at presentation if child presented during
that year
6
Age distribution of children infollow-up by
year, 1996-2008
N 357 411 489 552 645
742 842 966 1059 1128 1185
1203 1130
Age is taken to be age at start of the year, or
age at presentation if child presented during
that year
7
All hospital admissions during 2000-2007
Year Number Number Proportion
Total Rate ( children
children admitted number admissions
seen admitted
admissions per pyr)
2000 593 164 28
325 0.59 2001 654 175
27 309 0.51 2002
715 156 22 243
0.37 2003 817 182
22 314 0.42 2004 935
181 19 284 0.34
2005 1061 176 17
286 0.30 2006 1106
159 14 236 0.23 2007
1113 136 12 200
0.19
Retrospective data on admissions not collected
for children from clinics joining since Aug 2003.
These children are counted from when they begin
prospective follow-up in CHIPS. Admissions may be
underreported for children in shared care where
only information from the main CHIPS follow-up
clinic is reported. Data for 2008/9 are
incomplete and are not presented.
8
HIV-1 RNA suppression 12 months after starting
HAART naïveN763 with measurements available
(236 missing)
Year HIV-1 RNA (copies/ml)
50 or lower
assay limit 1997/99
73/161 (45) 2000/02
109/195 (56) 2003/05 190/278
(68) 2006- 95/129 (74)
Total 467/763 (61)
Response is based on the HIV-1 RNA value
nearest 12 months (/-3 months) after HAART
initiation 139/467 (30) of undetectable
results had a lower limit of detection gt50 but
400c/ml and are included here.
9
Time to viral rebound (gt1000c/ml) for children
suppressing HIV-1 RNA 400c/ml within 12 months
of starting HAART naïve, 2000-2003
Age at HAART lt2 years 2-4 years
5-9 years 10 years
10
Time to viral rebound (gt1000c/ml) for children
suppressing HIV-1 RNA 400c/ml within 12 months
of starting HAART naïve, 2004-2008
Age at HAART lt2 years 2-4 years
5-9 years 10 years
11
HIV-1 RNA 12 months1 after starting 1st and 2nd
line HAART for those switching2 to 2nd line
(N207 children switched to 2nd line after at
least 12 months on 1st line3)
Year starting 2nd-line HAART Number () 50c/ml or lower assay limit4 12 months after starting.... Number () 50c/ml or lower assay limit4 12 months after starting.... Number () 50c/ml or lower assay limit4 12 months after starting.... Number () 50c/ml or lower assay limit4 12 months after starting....
Year starting 2nd-line HAART 1st line HAART 1st line HAART 2nd line HAART 2nd line HAART
1997/2002 6/49 (12) 23/54 (43)
2003-2008 26/79 (33) 59/97 (61)
Total 32/128 (25) 82/151 (54)
1 Response is based on HIV-1 RNA value closest to
12 months (/-3 months) after starting 1st/ 2nd
line, for those starting HAART naive and
remaining on 1st line for at least 12 months and
2nd line for at least 12 months. 2 Defined as any
switch of 3 ART drugs (regardless of reason for
switch) or a switch of 2 ART drugs with reported
reasons being failure (immunological/virological
/clinical failure or resistance), with HIV-1 RNA
gt50 copies/ml. 3 56/207 had missing HIV-1 RNA
after 12 months on 2nd line, and a further 23/151
had missing HIV-1 RNA after 12 months on 1st
line. 4 30 (11) undetectable results had a
lower limit of detection gt50 but 400c/ml and are
included.
12
Data on 1169 children who are alive and in active
follow-up (1161 in CHIPS clinics and 8 who have
transferred to non-CHIPS clinics) Those who have
died, lost to follow-up, left the UK Ireland or
transferred to adult care are excluded.
13
Demographics (N1169) (Data provided by NSHPC)

• 601 (51) are female
• 583 (50) born UK/Ireland, 581 (50) born abroad
  (place of birth not known for 5 children)
• Ethnicity
• Diagnosis of maternal infection (N1137
  vertically infected)

White 84 (7 )
Black African 913 (78 )
Black other 11 (1 )
Indian SC 17 (1 )
Mixed 123 (11 )
Other 11 (1 )
Not known 10 (1 )
Known after delivery 966 (85 )
Known before delivery 140 (12 )
Not known 31 (3 )
14
Regional distribution ofmain follow-up clinic
for 1169 children alive and followed up in CHIPS
43 (4) Scotland
5 (0) N. Ireland
389 (33) Rest of England
57 (5) Ireland
15 (1) Wales
660 (56) London
Children who have died, lost to follow-up, left
the UK Ireland or transferred to adult care are
excluded
15
Year of last follow-up (N1169)
16
Clinical stage by age at last follow-up (N1169)
No. of children lt 2 years 2-4 years 5-9 years 10 years Total ()
Stage N/A 17 (53) 55 (57) 186 (53) 303 (44) 561 (48)
Stage B 2 (6) 14 (14) 71 (20) 221 (32) 308 (26)
Stage C 13 (41) 28 (29) 93 (27) 166 (24) 300 (26)
Total 32 (100) 97 (100) 350 (100) 690 (100) 1169 (100)
17
Antiretroviral drug experience N1143 children
with follow-up since January 2007
No. of children lt 2 years 2-4 years 5-9 years 10 years Total ()
Naive 7 (22) 31 (33) 80 (24) 100 (15) 218 (19)
1-4 drugs 23 (72) 51 (55) 172 (51) 272 (40) 518 (45)
5-7 drugs 2 (6) 10 (11) 75 (22) 185 (27) 272 (24)
8 drugs 0 (0) 1 (1) 10 (3) 124 (18) 135 (12)
18
ART at last follow-upN819 children with
follow-up since Jan 2007 were on treatment6 on
mono, 21 on dual, 712 on 3-drug, 70 on 4-drug
and 10 on 5()-drug therapy
19
Most recent CD4 (N1126)Children followed up
since January 2007 (missing for 17 children)
20
Most recent CD4 count (N1004)Children gt 5 years
old followed up since Jan 2007 (missing for 16
children)
21
Most recent HIV-1 RNA (N1123)Children followed
up since January 2007 (missing for 20 children)
14/1123 (1) of undetectable results had a
lower limit of detection gt50 but 400c/ml and are
included here.
22
Involvement in PENTA trials

• London - 22 children in PENPACT 1, 25 in PENTA 11
  (1 in adult care), 6 in PENTA 15 (1 left
  country).
• Direct linking centres - 4 children in PENPACT 1,
  1 in PENTA 11, 2 in PENTA 15.
• Midlands 1 child in PENTA 11, 5 in PENTA 15.
• South West South Wales 5 children in PENPACT
  1.
• North West North Wales - 2 children in PENPACT
  1, 1 (in adult care) in PENTA 11, 1 (in adult
  care) in PENTA 15.
• North East 2 children in PENPACT 1 (1 in to
  adult care).
• Ireland 3 children in PENPACT 1.

Location of last clinic reported to CHIPS
23
Recent CHIPS-related publications(based either
wholly or partly on CHIPS data)

• Foster C et al (2009) Young people in the UK and
  Ireland with perinatally acquired HIV the
  paediatric legacy for adult services. AIDS
  Patient Care STDs, 23 (3)159-166.
• Goetghebuer T et al (2009) Effect of early
  antiretroviral therapy on the risk of AIDS/death
  in HIV infected infants the European Infant
  Collaborative Study. AIDS, 23 597-604.
• Judd A et al (2009) Vertically acquired HIV
  diagnosed in adolescence and early adulthood in
  the UK and Ireland findings from national
  surveillance HIV Medicine, 10 253-256.
• Judd A et al (2009) Effect of tenofovir
  disoproxil fumarate (TDF) on risk of renal
  impairment in HIV-1 infected children on
  antiretroviral therapy nested case-control
  study. 16th CROI, Montreal (poster).
• Kekitiinwa A et al (2008) Differences in factors
  associated with initial growth, CD4 and viral
  load response to ART in Ugandan and UK/ Irish
  HIV-infected children. JAIDS, 49(4) 384-392.
• Riordan A et al (2009) Tenofovir use in human
  immunodeficiency virus -1 infected children in
  the United Kingdom and Ireland. PIDJ, 28(3)204-9
• Walker AS et al (2009) To overdose or underdose?
  The question of Kaletra in children in the
  UK/Irish Collaborative HIV Paediatric Study
  (CHIPS). Ninth International Congress on Drug
  Therapy in HIV Infection, Glasgow (oral).

24
Acknowledgements

• We thank the families and staff at hospitals
  which participate in CHIPS.CHIPS is funded by
  the Department of Health, and has received
  additional support from Bristol-Myers Squibb,
  Boehringer Ingelheim, GlaxoSmithKline, Roche,
  Abbott and Gilead.
• For further information on CHIPS, please visit
• www.chipscohort.ac.uk