Higher rates of triple‐class virological failure in perinatally HIV‐infected teenagers compared with heterosexually infected young adults in Europe. Issue 3 (14th September 2016)

• Record Type: Journal Article
• Authors: Judd, A; Lodwick, R; Noguera‐Julian, A; Gibb, DM; Butler, K; Costagliola, D; Sabin, C; van Sighem, A; Ledergerber, B; Torti, C; Mocroft, A; Podzamczer, D; Dorrucci, M; De Wit, S; Obel, N; Dabis, F; Cozzi‐Lepri, A; García, F; Brockmeyer, NH; Warszawski, J; Gonzalez‐Tome, MI; Mussini, C; Touloumi, G; Zangerle, R; Ghosn, J; Castagna, A; Fätkenheuer, G; Stephan, C; Meyer, L; Campbell, MA; Chene, G; Phillips, A;
• Other Names: Mary Krause Murielle investigator.; Leport Catherine investigator.; Wittkop Linda investigator.; Reiss Peter investigator.; Wit Ferdinand investigator.; Prins Maria investigator.; Bucher Heiner investigator.; Gibb Diana investigator.; Amo Julia Del investigator.; Thorne Claire investigator.; Kirk Ole investigator.; Pérez‐Hoyos Santiago investigator.; Hamouda Osamah investigator.; Bartmeyer Barbara investigator.; Chkhartishvili Nikoloz investigator.; Antinori Andrea investigator.; Monforte Antonella d'Arminio investigator.; Prieto Luis investigator.; Rojo Pablo investigator.; Soriano‐Arandes Antoni investigator.; Battegay Manuel investigator.; Kouyos Roger investigator.; Tookey Pat investigator.; Casabona Jordi investigator.; Miró Jose M. investigator.; Konopnick Deborah investigator.; Goetghebuer Tessa investigator.; Sönnerborg Anders investigator.; Teira Ramon investigator.; Garrido Myriam investigator.; Haerry David investigator.; Raben Dorthe investigator.; Chêne Geneviève investigator.; Barger Diana investigator.; Schwimmer Christine investigator.; Termote Monique investigator.; Frederiksen Casper M. investigator.; Friis‐Møller Nina investigator.; Kjaer Jesper investigator.; Salbøl Brandt Rikke investigator.; Berenguer Juan investigator.; Bohlius Julia investigator.; Bouteloup Vincent investigator.; Davies Mary‐Anne investigator.; Dunn David investigator.; Egger Matthias investigator.; Furrer Hansjakob investigator.; Guiguet Marguerite investigator.; Grabar Sophie investigator.; Lambotte Olivier investigator.; Leroy Valériane investigator.; Lodi Sara investigator.; Matheron Sophie investigator.; Monge Susana investigator.; Nakagawa Fumiyo investigator.; Paredes Roger investigator.; Puoti Massimo investigator.; Schomaker Michael investigator.; Smit Colette investigator.; Sterne Jonathan investigator.; Thiebaut Rodolphe investigator.; Thorne Claire investigator.; van der Valk Marc investigator.; Wyss Natasha investigator.;
• Is Part Of: HIV medicine. Volume 18:Issue 3(2017:Mar.)
• Page Start: 171
• Page End: 180
• Publication Date: 2016-09-14
• Subjects: Europe -- perinatal HIV infection -- virological failure -- young people; HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12411
• Languages: English
• ISSNs: 1464-2662

Abstract

Abstract : Objectives: The aim of the study was to determine the time to, and risk factors for, triple‐class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. Methods: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15–29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV‐1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. Results: The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4–111) vs . 8 (IQR 2–38) weeks, respectively], and highest in perinatally infected participants aged 10–14 years [49 (IQR 9–267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0−12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9−5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10–14 years when starting ART (27.7%; 95% CI 13.2−42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10–14 years, African origin, pre‐ART AIDS, NNRTI‐based initial regimens, higher pre‐ART viral load and lower pre‐ART CD4. Conclusions: The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.