St' Georges Hospital HIV specialist Clinic

1
Data from the Collaborative HIV Paediatric
Study (CHIPS) Reports up to March 2008
Numbers are based on reports received rather than
children seen to the end of March 2008. 2007/8
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 infected children in the UK
  and Ireland.
• The collaboration is between
• 59 centres 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 1460 children enrolled in
CHIPS
83 deaths prior to 2005, 3 in 2005, 4 in 2006,
1 in 2007.
4
Age/year at first presentation to medical
services in the UK/Ireland (N1460)
Up to 2004 2005 2006
2007 Total At birth 121 (10)
11 (10) 6 (7) 2 (4) 140 (10)
lt1 yr 288 (24) 11 (10) 13
(15) 6 (12) 318 (22) 1-4 yrs
400 (33) 17 (15) 22 (25) 8 (16)
447 (31) 5-9 yrs 274 (23) 47
(42) 24 (28) 19 (39) 364 (25)
gt10 yrs 129 (11) 26 (23) 22 (25)
14 (29) 191 (13) Total 1212
(100) 112 (100) 87 (100) 49 (100)
1460 (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 over
calendar time
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 488 6.0 (3.3-8.9)
21(4) 168(34) 211(43) 78(16) 10(2)
1999 550 6.7 (3.7-9.8) 23(4) 168(31)
229(42) 112(20) 18(3) 2000 642
7.3 (4.1-10.5) 21(3) 185(29) 254(40)
143(22) 39(6) 2001 737 7.8
(4.7-11.1) 17(2) 190(26) 286(39) 197(27)
47(6) 2002 834 8.1 (5.1-11.7)
21(3) 178(21) 334(40) 236(28) 65(8)
2003 957 8.6 (5.7-12.1) 20(2) 177(18)
374(39) 300(31) 86(9) 2004 1047
9.2 (6-12.6) 19(2) 174(17) 396(38)
343(33) 115(11) 2005 1110 9.6
(6.6-13) 17(2) 143(13) 425(38) 382(34)
143(13) 2006 1138 10.3 (7-13.5)
13(1) 132(12) 396(35) 409(36) 188(17)
2007 1073 10.7 (7.6-13.9) 8(1) 113(11)
347(32) 418(39) 187(17)
Age is taken to be age at start of the year, or
age at presentation if child presented during
that year
6
All hospital admissions during 2000-2006
Year Number Number Proportion
Total Rate ( children
children admitted number admissions
seen admitted
admissions per pyr)
2000 592 164 28
325 0.60 2001 653
175 27 309 0.51 2002
713 155 22 242
0.37 2003 814 178
22 308 0.42 2004
928 179 19 282
0.34 2005 1051 173 16
283 0.30 2006 1077
148 14 220 0.22
Retrospective data on admissions not collected
for children from centres 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
centre is reported. Data for 2007/8 are
incomplete and are not presented.
7
HIV-1 RNA 12 months after starting HAART naïve
N691 with measurements available (214 missing)
Year HIV RNA (copies/ml)
50 51-400 gt400
Total 1997/99 39 (24) 44 (27) 78
(48) 161 (100) 2000/01 36 (30) 38
(31) 47 (39) 121 (100) 2002/03 78
(47) 46 (28) 41 (25) 165 (100)
2004/05 103 (56) 45 (24) 36 (20)
184 (100) 2006- 30 (50) 20 (33)
10 (17) 60 (100) Total 286 (41)
193 (28) 212 (31) 691 (100)
Response is based on the HIV-1 RNA value
closest to 12 months (/-3 months) after HAART
initiation
8
Time to viral rebound (gt1000c/ml) for children
suppressing HIV-1 RNA 400c/ml within 12 months
of starting HAART naïve, 2000-2003
Age lt2 years 2-4 years 5-9
years 10 years
9
Time to viral rebound (gt1000c/ml) for children
suppressing HIV-1 RNA 400c/ml within 12 months
of starting HAART naïve, 2004-2007
Age lt2 years 2-4 years 5-9
years 10 years
10
Data on 1142 children who are alive and in active
follow-up (1130 in CHIPS centres and 12 who
have transferred to non-CHIPS centres) Those who
have died, lost to follow-up, left the UK
Ireland or transferred to adult care are excluded.
11
Demographics (N1142) (Data provided by NSHPC)

• 594 (52) are female
• 573 (50) born UK/Ireland, 565 (49) born abroad
  (place of birth not known for 4 children)
• Ethnicity
• Diagnosis of maternal infection (N1107
  vertically infected)

12
Regional distribution ofmain follow-up centre
for 1142 children alive and followed up in CHIPS
36 (3) Scotland
5 (0) N. Ireland
350 (31) Rest of England
60 (5) Ireland
15 (1) Wales
676 (59) London
Children who have died, lost to follow-up, left
the UK Ireland or transferred to adult care are
excluded
13
Year of last follow-up (N1142)
14
Clinical stage by age at last follow-up (N1142)
15
Antiretroviral drug experience N1110 children
with follow-up since January 2006
16
ART at last follow-upN744 children with
follow-up since Jan 2006 were on treatment8 on
mono, 18 on dual, 652 on 3-drug, 60 on 4-drug
and 6 on 5()-drug therapy
17
Most recent CD4 (N1094)Children followed up
since January 2006 (missing for 16 children)
18
Most recent CD4 count (N958)Children gt 5 years
old followed up since January 2006 (missing for
16 children)
19
Most recent HIV RNA (N1099)Children followed up
since January 2006 (missing for 11 children)
20
Involvement in PENTA trials

• London - 22 children in PENPACT 1, 26 in PENTA
  11, 5 in PENTA 15.
• Direct linking centres - 4 children in PENPACT 1,
  2 in PENTA 15.
• Midlands 1 child in PENTA 11, 3 in PENTA 15.
• South West South Wales 5 children in PENPACT
  1.
• North West North Wales - 2 children in PENPACT
  1, 1 in PENTA 11, 1 in PENTA 15.
• North East 2 children in PENPACT 1.
• Ireland 3 children in PENPACT 1.

21
Recent CHIPS-related publications(based either
wholly or partly on CHIPS data)

• The Collaboration of Observational HIV
  Epidemiological Research Europe (COHERE) study
  group. Response to combination antiretroviral
  therapy (cART) variation by age. AIDS in
  press.Chakraborty R, Smith CJ, Dunn D et al.
  HIV-1 Drug Resistance in HIV-1 Infected Children
  in the United Kingdom from 1998 to 2004.
  Paediatric Infectious Disease Journal 2008 27
  457-459.Lee, KJ, Shingadia D, Pillay D et al.
  Transient viral load increases in HIV-infected
  children in the UK and Ireland what do they
  mean? Antiviral Therapy 2007 12(6)
  949-956.Judd A, Doerholt K, Tookey PA et al.
  Morbidity, mortality, and response to treatment
  by children in the United Kingdom and Ireland
  with perinatally acquired HIV infection during
  1996-2006 planning for teenage and adult care.
  Clinical Infectious Diseases 200745(7)918-924.
  Goetghebuer T, Haelterman E, Le Chenadec et al.
  Effect of early antiretroviral therapy on the
  risk of AIDS/ death in HIV infected infants the
  European Infant Collaborative Study. NEJM -
  under review.
• Kekitiinwa A, Lee KJ, Walker AS, et al.
  Differences in factors associated with initial
  growth, CD4 and viral load response to ART in
  Ugandan and UK/ Irish HIV-infected children.
  JAIDS - under review.
• Foster C, Judd A, Tookey PA et al. Young people
  in the UK and Ireland with perinatally acquired
  HIV the paediatric legacy for adult services.
  Submitted.

22
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