Wednesday, 25th of July 2012 |
Presented by Elizabeth R Wolf (Botswana).
E.R. Wolf1,2, K.E. Wirth3, A. Ho-Foster4, D. Goldfarb5, M. Tolle6, I. Makone7, C. Jacovides8, M. Chise1, A.P. Steenhoff4,9
1University of Botswana School of Medicine, Gaborone, Botswana, 2University of Washington, Seattle, United States, 3Harvard School of Public Health, Cambridge, United States, 4Botswana-UPenn Partnership, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States, 5McMaster University, Hamilton, Canada, 6Baylor College of Medicine International Pediatric AIDS Initiative, Houston, United States, 7Princess Marina Hospital, Gaborone, Botswana, 8University of Pennsylvania Perelman School of Medicine, Philadelphia, United States, 9Children's Hospital of Philadelphia, Philadelphia, United States
Also accessible at http://pag.aids2012.org/abstracts.aspx?aid=14589
Background: It has been proposed that the mechanism of HIV viral load (VL) reduction during acute measles is through suppression of CD4 cell proliferation. Our study examined the effect of measles on CD4% and VL of HIV+ children and adolescents in Botswana during the 2009-2010 measles epidemic.
Methods: We retrospectively examined the records of 2,011 pediatric (0-18 years) HIV+ patients attending the Botswana-Baylor Children's Clinical Center of Excellence for measles infection. Measles cases were classified by a positive measles IgM or by meeting clinical criteria for measles as defined by the World Health Organization. We used linear regression with generalized estimating equations to assess the effect of measles on CD4% and log VL. We adjusted for age, sex, nutritional status, WHO stage, and exposure to and duration of antiretroviral therapy (ART).
Results: We identified 195 measles cases (45.6% male) with median age of 13.2 years (interquartile range (IQR): 10.3-15.3). Baseline median CD4% was 29% (IQR: 23%-35%). Of cases, 85% were on ART, of whom 97% had an undetectable (< 400 copies/mL) VL at baseline. Two deaths (case fatality rate (CFR) = 1%) were felt to be measles related.
[Measles cases (n=195) in the study population]
Amongst cases, CD4% declined by 5.5 percentage points (95% CI: 0.1-11.0) in the first month following measles. By 6 months post-measles, we found no significant difference in CD4% compared to baseline (P = 0.44). In patients without measles, CD4% remained stable over the entire study period. We found no significant difference in log VL between pre- and post-measles visits (P = 0.11).
Conclusions: Measles was associated with a significant but temporary CD4% immunosuppression among a cohort of HIV+ children and adolescents living in Botswana, most of whom were on ART. This may help explain the significant morbidity of measles in HIV+ patients, even amongst those who are virologically suppressed. CFR in the cohort, however, was low.
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