Ragna S Boerma1,2, Cissy Kityo3, T Sonia Boender1,2,4, Elizabeth Kaudha3, Joshua Kayiwa4, Victor Musiime5, Andrew Mukuye4, Mary Kiconco4, Immaculate Nankya4, Lilian Nakatudde4, Peter N Mugyenyi4, Michael Boele van Hensbroek2, Tobias F Rinke de Wit1, Kim C E Sigaloff1,6, Job C J Calis2,7. 1. Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands. 2. Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands. 3. Joint Clinical Research Centre, Kampala, Uganda. 4. Stichting HIV Monitoring, Amsterdam, the Netherlands. 5. Department of Pediatrics and Child Health, Makerere College of Health Sciences, Kampala, Uganda. 6. Department of Infectious Diseases, Division of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands. 7. Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.
Abstract
Background: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens. Methods: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml. Results: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure. Conclusions: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.
Background: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens. Methods:Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml. Results: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure. Conclusions: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.
Authors: Vinie Kouamou; Justen Manasa; David Katzenstein; Alan M McGregor; Chiratidzo E Ndhlovu; Azure T Makadzange Journal: AIDS Date: 2019-09-01 Impact factor: 4.177
Authors: M H W Huibers; P Moons; M Cornelissen; F Zorgdrager; N Maseko; M B Gushu; O H Iwajomo; M Boele van Hensbroek; J C J Calis Journal: J Antimicrob Chemother Date: 2018-12-01 Impact factor: 5.790
Authors: Cissy Kityo; Ragna S Boerma; Kim C E Sigaloff; Elizabeth Kaudha; Job C J Calis; Victor Musiime; Sheila Balinda; Rita Nakanjako; T Sonia Boender; Peter N Mugyenyi; Tobias F Rinke de Wit Journal: J Antimicrob Chemother Date: 2017-09-01 Impact factor: 5.790