Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort. (1st June 2018)

• Record Type: Journal Article
• Authors: Wools-Kaloustian, Kara; Marete, Irene; Ayaya, Samuel; Sohn, Annette H.; Van Nguyen, Lam; Li, Shanshan; Leroy, Valériane; Musick, Beverly S.; Newman, Jamie E.; Edmonds, Andrew; Davies, Mary-Ann; Eboua, François T.; Obama, Marie-Thérèse; Yotebieng, Marcel; Sawry, Shobna; Mofenson, Lynne M.; Yiannoutsos, Constantin T.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 78:Number 2(2018)
• Publication Date: 2018-06-01
• Subjects: HIV -- children -- ART -- failure -- first-line -- second-line; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000001667
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. Methods: Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. Results: In 27, 031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ⩽5 years of age was 13.2% and CD4 count for those >5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor–based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively. Conclusions: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years.