Highlights from the 9th International Workshop on Pediatrics 21-22 July 2017, Paris France.

The 9 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.

Table 1.

Use of infant non-human primates (NHP) for HIV/AIDS research priorities

Research priority	NHP model
Transmission	Breastfeeding infection model: • Postpartum SIV infection of dam • Oral SIV inoculation of infant In utero/intrapartum infection model: • SIV inoculation of amniotic fluid
Pathogenesis	Comparative model of pathogenic SIV infection in macaques and non-pathogenic SIV infection in natural hosts
Persistence/cure	SIV/SHIV-infected, ART-suppressed macaques • Test novel interventions • Investigate anatomical reservoirs
Prevention	Active and passive immunisation of macaques with SIV/SHIV challenge

SIV: simian immunodeficiency virus; SHIV: simian human immunodeficiency virus; ART: antiretroviral therapy.