David C Boettiger1, Tavitiya Sudjaritruk2, Revathy Nallusamy3, Pagakrong Lumbiganon4, Supattra Rungmaitree5, Rawiwan Hansudewechakul6, Nagalingeswaran Kumarasamy7, Torsak Bunupuradah8, Vonthanak Saphonn9, Khanh Huu Truong10, Nik K N Yusoff11, Viet Chau Do12, Lam V Nguyen13, Kamarul A M Razali14, Siew Moy Fong15, Nia Kurniati16, Azar Kariminia17. 1. Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia. Electronic address: dboettiger@kirby.unsw.edu.au. 2. Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. 3. Department of Pediatrics, Penang Hospital, Malaysia. 4. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 5. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 6. Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand. 7. YRG CARE Medical Centre, CART CRS, Chennai, India. 8. HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 9. National Centre for HIV/AIDS Dermatology and STDs, University of Health Sciences, Phnom Penh, Cambodia. 10. Department of Infectious Diseases, Children's Hospital 1, Ho Chi Minh City, Vietnam. 11. Department of Pediatrics, Hospital Raja Perempuan Zainab II, Malaysia. 12. Department of Infectious Diseases, Children's Hospital 2, Ho Chi Minh City, Vietnam. 13. National Hospital of Pediatrics, Hanoi, Vietnam. 14. Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. 15. Hospital Likas, Kota Kinabalu, Malaysia. 16. Department of Child Health, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. 17. Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
Abstract
PURPOSE: About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population. METHODS: Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL. RESULTS: Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm(3). The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count ≤200 cells/mm(3) (HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure. CONCLUSIONS: Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.
PURPOSE: About a third of untreated, perinatally HIV-infectedchildren reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population. METHODS: Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL. RESULTS: Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm(3). The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count ≤200 cells/mm(3) (HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure. CONCLUSIONS: Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.
Authors: Winstone M Nyandiko; Samuel Ayaya; Esther Nabakwe; Constance Tenge; John E Sidle; Constantin T Yiannoutsos; Beverly Musick; Kara Wools-Kaloustian; William M Tierney Journal: J Acquir Immune Defic Syndr Date: 2006-12-01 Impact factor: 3.731
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: C Chintu; G J Bhat; A S Walker; V Mulenga; F Sinyinza; K Lishimpi; L Farrelly; N Kaganson; A Zumla; S H Gillespie; A J Nunn; D M Gibb Journal: Lancet Date: 2004 Nov 20-26 Impact factor: 79.321
Authors: Lee Fairlie; Brad Karalius; Kunjal Patel; Russell B van Dyke; Rohan Hazra; Miguel A Hernán; George K Siberry; George R Seage; Allison Agwu; Andrew Wiznia Journal: AIDS Date: 2015-10-23 Impact factor: 4.177
Authors: Stephen Wright; Mark A Boyd; Evy Yunihastuti; Matthew Law; Thira Sirisanthana; Jennifer Hoy; Sanjay Pujari; Man Po Lee; Kathy Petoumenos Journal: PLoS One Date: 2013-06-28 Impact factor: 3.240