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J Adolesc Health. 2016 Apr;58(4):451-459. doi: 10.1016/j.jadohealth.2015.11.006. Epub 2016 Jan 20.

Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia.

Author information

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.

KEYWORDS:

Antiretroviral therapy; Cotrimoxazole; HIV; Non-nucleoside reverse-transcriptase inhibitor; Perinatal HIV infection

PMID:
26803201
PMCID:
PMC4808326
DOI:
10.1016/j.jadohealth.2015.11.006
[Indexed for MEDLINE]
Free PMC Article

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