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AIDS Res Hum Retroviruses. 2017 Mar;33(3):230-233. doi: 10.1089/AID.2016.0039. Epub 2016 Oct 31.

Short Communication: Impact of Viral Load Use on Treatment Switch in Perinatally HIV-Infected Children in Asia.

Author information

1
1 Pediatric Institute , Hospital Kuala Lumpur, Kuala Lumpur, Malaysia .
2
2 HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
3
3 Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand .
4
4 Hospital Raja Perempuan Zainab II , Kelantan, Malaysia .
5
5 Chiangrai Prachanukroh Hospital , Chiang Rai, Thailand .
6
6 National Centre for HIV/AIDS , Dermatology and STDs, Phnom Penh, Cambodia .
7
7 National Hospital of Pediatrics , Hanoi, Vietnam .
8
8 Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University , Chiang Mai, Thailand .
9
9 Department of Pediatrics, Khon Kaen University , Khon Kaen, Thailand .
10
10 Children's Hospital 2 , Ho Chi Minh City, Vietnam .
11
11 Cipto Mangunkusumo General Hospital , Jakarta, Indonesia .
12
12 YRGCARE Medical Centre , CART CRS, Chennai, India .
13
13 Sanglah Hospital, Udayana University , Bali, Indonesia .
14
14 Hospital Likas , Kota Kinabalu, Malaysia .
15
15 Penang Hospital , Penang, Malaysia .
16
16 The Kirby Institute , UNSW Australia, Sydney, Australia .
17
17 TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok, Thailand .

Abstract

We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.

KEYWORDS:

HIV; antiretroviral therapy; molecular virology

PMID:
27758114
PMCID:
PMC5333561
DOI:
10.1089/AID.2016.0039
[Indexed for MEDLINE]
Free PMC Article

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