Virologic failure and second-line antiretroviral therapy in children in South Africa-the IeDEA Southern Africa collaboration
Date
2011
Authors
Davies M.-A.
Moultrie H.
Eley B.
Rabie H.
Van Cutsem G.
Giddy J.
Wood R.
Technau K.
Keiser O.
Egger M.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: With expanding pediatric antiretroviral therapy (ART) access, children will begin to experience treatment failure and require second-line therapy. We evaluated the probability and determinants of virologic failure and switching in children in South Africa. Methods: Pooled analysis of routine individual data from children who initiated ART in 7 South African treatment programs with 6-monthly viral load and CD4 monitoring produced Kaplan-Meier estimates of probability of virologic failure (2 consecutive unsuppressed viral loads with the second being >1000 copies/mL, after 24 weeks of therapy) and switch to second-line. Cox-proportional hazards models stratified by program were used to determine predictors of these outcomes. Results: The 3-year probability of virologic failure among 5485 children was 19.3% (95% confidence interval: 17.6 to 21.1). Use of nevirapine or ritonavir alone in the initial regimen (compared with efavirenz) and exposure to prevention of mother to child transmission regimens were independently associated with failure [adjusted hazard ratios (95% confidence interval): 1.77 (1.11 to 2.83), 2.39 (1.57 to 3.64) and 1.40 (1.02 to 1.92), respectively]. Among 252 children with 1 year follow-up after failure, 38% were switched to second-line. Median (interquartile range) months between failure and switch was 5.7 (2.9-11.0). Conclusions: Triple ART based on nevirapine or ritonavir as a single protease inhibitor seems to be associated with a higher risk of virologic failure. A low proportion of virologically failing children were switched. Copyright © 2011 by Lippincott Williams & Wilkins.
Description
Keywords
efavirenz, lamivudine, lopinavir, nevirapine, ritonavir, stavudine, zidovudine, article, CD4 lymphocyte count, child, female, follow up, highly active antiretroviral therapy, human, Human immunodeficiency virus infection, major clinical study, male, preschool child, priority journal, probability, South Africa, treatment duration, treatment failure, vertical transmission, virology, virus load, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Child, Child, Preschool, Drug Monitoring, Female, HIV Infections, Humans, Infant, Male, Nevirapine, Pregnancy, Ritonavir, Salvage Therapy, South Africa, Treatment Failure, Viral Load
Citation
Journal of Acquired Immune Deficiency Syndromes
56
3
56
3