Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy - HAL-SHS - Sciences de l'Homme et de la Société Accéder directement au contenu
Article Dans Une Revue Clinical Infectious Diseases Année : 2015

Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy

Rapeepan Suaysod
  • Fonction : Auteur
Nicole Ngo-Giang-Huong
  • Fonction : Auteur
Nicolas Salvadori
  • Fonction : Auteur
Timothy Cressey
  • Fonction : Auteur
Suparat Kanjanavanit
  • Fonction : Auteur
Pornchai Techakunakorn
  • Fonction : Auteur
Sawitree Krikajornkitti
  • Fonction : Auteur
Sakulrat Srirojana
  • Fonction : Auteur
Laddawan Laomanit
  • Fonction : Auteur
Suwalai Chalermpantmetagul
  • Fonction : Auteur
Marc Lallemant
  • Fonction : Auteur
Ken Mcintosh
  • Fonction : Auteur
Patrinee Traisathit
  • Fonction : Auteur
Gonzague Jourdain

Résumé

BACKGROUND: Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure. METHODS: HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure. RESULTS: A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age >13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001). CONCLUSIONS: Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored.

Dates et versions

hal-02082666 , version 1 (28-03-2019)

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Citer

Rapeepan Suaysod, Nicole Ngo-Giang-Huong, Nicolas Salvadori, Timothy Cressey, Suparat Kanjanavanit, et al.. Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy. Clinical Infectious Diseases, 2015, 61 (1), pp.95-101. ⟨10.1093/cid/civ271⟩. ⟨hal-02082666⟩
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