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Title
Uptake and outcomes of tenofovir alafenamide fumarate (TAF) –based therapy in children and young people living with HIV (CLWHIV) in the European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC)
Presenter
Siobhan Crichton
Authors
S. Crichton1, E. Chappell1, K. Doerholt2, M. Navarro3, A. Noguera-Julian4, V. Spoulou5, C. Teixeira6, A. Judd1, I.J. Collins1, European Pregnancy and Paediatric Infections Cohort Collaboration
Institutions
1University College London, MRC Clinical Trials Unit, London, United Kingdom, 2St George’s University Hospitals, London, United Kingdom, 3Hospital General Universitario "Gregorio Marañón", CIBERINFEC ISCIII, Madrid, Spain, 4Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain, 5"Agia Sofia" Children's Hospital, 1st Dept of Paediatrics, Athens, Greece, 6Centro Hospitalar e Universitário do Porto, Porto, Portugal

BACKGROUND: TAF was originally approved in Europe for CLWHIV aged =6 years in 2016, initially as part of fixed-dose combinations (some approvals were extended to age =2 years in 2022). Data are limited on TAF uptake and outcomes in this population.
METHODS: CLWHIV aged<18 years at HIV diagnosis and followed in 11 cohorts across Europe were included. Uptake of TAF, characteristics at TAF start and viral suppression (VS) (viral load (VL)<50c/ml) at 6, 12 and 18-months on TAF were described by treatment and VL status at TAF start.
RESULTS: Of 3318 in follow-up since 2016, 670 (20%) ever received TAF; 56% were female; 95% perinatally acquired HIV or were aged<10 years at entry to HIV care; 36% from the UK, 26% Spain, 24% Italy, 15% elsewhere in Europe; median age at ART initiation was 3.5[IQR 0.6,8.8] years.
At TAF start 11% were aged 5-11, 24% 12-17, 27% 18-23 and 20% =24 years. Half (48%) were on an INSTI-based regimen, 31% PI, 13% NNRTI, 7% other/multiple classes; 66% previously used TDF. Twenty-one (3%) were treatment naïve and 649 (97%) treatment-experienced, of whom 51% had VL<50, 24% were viremic (VL=50) and 25% had unknown VL at TAF start. Those treatment-experienced and viremic, and those naïve, had the lowest CD4 counts (Table). Median duration on TAF was 1.2[0.6,2.0] years. At 6, 12 and 18-months on TAF, overall VS was >80% but was lower in those treatment-experienced and viremic at TAF start.

Table: Characteristics at start of TAF by treatment status and viral load
(Median [IQR])
Naïve, n=21
Treatment experienced, VL<50, n=330
Treatment experienced, VL=50, n=157
Treatment experienced, VL unknown, n=162
Age (years)
14.8[14.2,16.4]
17.1[13.8,22.1]
17.7[15.0,22.0]
20.1[14.6,22.8]
CD4 count (n=19,273,147,47)
373[211,660]
720[575,951]
482[299,670]
644[468,898]
Log viral load(n=18,157)
4.2[3.5,5.1]

3.4[2.5,4.3]



CONCLUSIONS: CLWHIV who were virally suppressed at TAF start maintained good levels of suppression over follow-up, and two-thirds of those who were treatment-experienced and viremic at TAF start achieved viral suppression. Longer-term follow-up data are needed, particularly in younger children.

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