Risk of First-line Antiretroviral Therapy Failure in HIV-infected Thai Children and Adolescents. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Bunupuradah, Torsak; Sricharoenchai, Sirintip; Hansudewechakul, Rawiwan; Klinbuayaem, Virat; Teeraananchai, Sirinya; Wittawatmongkol, Orasri; Akarathum, Noppadon; Prasithsirikul, Wisit; Ananworanich, Jintanat
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 3(2015)
• Publication Date: 2015-03
• Subjects: Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000584
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Adolescence may affect adherence and response to highly active antiretroviral therapy (HAART). Limited data are available regarding the long-term treatment outcomes of perinatal HIV-infected adolescents. Methods: Data from perinatally acquired HIV-infected Thai children who started first-line nonnucleoside analog-based HAART before 18 years of age and treated for ≥24 weeks were analyzed. Children were categorized by age at HAART initiation; age <3 years, 3–9 years, early adolescence (10–13 years) and middle adolescence (14–16 years). CD4 and HIV-RNA were monitored every 6–12 months. Virologic failure (VF) was defined as HIV-RNA ≥ 1000 copies/mL after ≥24 weeks of HAART. Results: Of 840 children, 68% were in pre-adolescence. Median baseline CD4% was 7.9%. Use of nevirapine versus efavirenz was 77:23%. Median duration of nonnucleoside reverse transcriptase inhibitor-based HAART was 5.6 years. No differences between groups were observed for rate of HIV-RNA < 50 copies/mL (68%, P = 0.18) and rate of VF (28%, P = 0.82), median time to VF (22 months, P = 0.13). Incidence of VF per 100 child-year in children age <3 years, 3–9 years, early adolescence and middle adolescence were 7.9, 4.7, 7.4 and 10.8, respectively ( P = 0.012). Median adherence by pill count was 97.3% ( P = 0.23). By multivariate analysis, predictors for VF were age at HAART initiation of <3 years (HR: 1.73, 95% CI: 1.18–2.55), age 10–16 years (HR: 1.47, 95% CI: 1.09–1.97), and nevirapine use (HR: 1.63, 95% CI: 1.14–2.32). Conclusions: VF rates were observed in one-third of long-term treated Thai children on first-line HAART. Age 3–9 years at HAART initiation was associated with less VF compared with those younger or older, whereas children who used nevirapine had higher VF. Abstract : Supplemental Digital Content is available in the text.