Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand

European Pregnancy Paediat HIV Coh

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    Abstract

    Background. Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand.

    Methods. Children aged <18 years initiating combination ART (>= 2 nucleoside reverse transcriptase inhibitors p[NRTIs] plus nonnucleoside reverse transcriptase inhibitor p[NNRTI] or boosted protease inhibitor p[PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of >= 1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks.

    Results. Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch.

    Conclusions. One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.

    Original languageEnglish
    Pages (from-to)594-603
    Number of pages10
    JournalClinical Infectious Diseases
    Volume66
    Issue number4
    DOIs
    Publication statusPublished - 15-Feb-2018

    Keywords

    • HIV
    • children
    • antiretroviral therapy
    • second-line
    • switch
    • HIV-1 DRUG-RESISTANCE
    • VIROLOGICAL FAILURE
    • INFECTED CHILDREN
    • RANDOMIZED-TRIAL
    • VIRAL LOAD
    • OPEN-LABEL
    • SCALE-UP
    • ADOLESCENTS
    • INFANTS
    • ADULTS

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