Virologic failure and second-line antiretroviral therapy in children in South Africa-the IeDEA Southern Africa collaboration

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dc.contributor.authorDavies M.-A.
dc.contributor.authorMoultrie H.
dc.contributor.authorEley B.
dc.contributor.authorRabie H.
dc.contributor.authorVan Cutsem G.
dc.contributor.authorGiddy J.
dc.contributor.authorWood R.
dc.contributor.authorTechnau K.
dc.contributor.authorKeiser O.
dc.contributor.authorEgger M.
dc.contributor.authorBoulle A.
dc.date.accessioned2011-05-15T16:16:48Z
dc.date.available2011-05-15T16:16:48Z
dc.date.issued2011
dc.description.abstractBackground: 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.
dc.description.versionArticle
dc.identifier.citationJournal of Acquired Immune Deficiency Syndromes
dc.identifier.citation56
dc.identifier.citation3
dc.identifier.issn15254135
dc.identifier.other10.1097/QAI.0b013e3182060610
dc.identifier.urihttp://hdl.handle.net/10019.1/13945
dc.subjectefavirenz
dc.subjectlamivudine
dc.subjectlopinavir
dc.subjectnevirapine
dc.subjectritonavir
dc.subjectstavudine
dc.subjectzidovudine
dc.subjectarticle
dc.subjectCD4 lymphocyte count
dc.subjectchild
dc.subjectfemale
dc.subjectfollow up
dc.subjecthighly active antiretroviral therapy
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infection
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectpreschool child
dc.subjectpriority journal
dc.subjectprobability
dc.subjectSouth Africa
dc.subjecttreatment duration
dc.subjecttreatment failure
dc.subjectvertical transmission
dc.subjectvirology
dc.subjectvirus load
dc.subjectAnti-HIV Agents
dc.subjectAntiretroviral Therapy, Highly Active
dc.subjectCD4 Lymphocyte Count
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectDrug Monitoring
dc.subjectFemale
dc.subjectHIV Infections
dc.subjectHumans
dc.subjectInfant
dc.subjectMale
dc.subjectNevirapine
dc.subjectPregnancy
dc.subjectRitonavir
dc.subjectSalvage Therapy
dc.subjectSouth Africa
dc.subjectTreatment Failure
dc.subjectViral Load
dc.titleVirologic failure and second-line antiretroviral therapy in children in South Africa-the IeDEA Southern Africa collaboration
dc.typeArticle
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