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Wools-Kaloustian, Kara; Marete, Irene; Ayaya, Samuel; Sohn, Annette H.; Van Nguyen, Lam; Li, Shanshan; Leroy, Valériane; Musick, Beverly S.; Newman, Jamie E.; Edmonds, Andrew; Davies, Mary-Ann; Eboua, François T.; Obama, Marie-Thérèse; Yotebieng, Marcel; Sawry, Shobna; Mofenson, Lynne M.; Yiannoutsos, Constantin T.

Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

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  • Media type: E-Article
  • Title: Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort
  • Contributor: Wools-Kaloustian, Kara; Marete, Irene; Ayaya, Samuel; Sohn, Annette H.; Van Nguyen, Lam; Li, Shanshan; Leroy, Valériane; Musick, Beverly S.; Newman, Jamie E.; Edmonds, Andrew; Davies, Mary-Ann; Eboua, François T.; Obama, Marie-Thérèse; Yotebieng, Marcel; Sawry, Shobna; Mofenson, Lynne M.; Yiannoutsos, Constantin T.
  • imprint: Ovid Technologies (Wolters Kluwer Health), 2018
  • Published in: JAIDS Journal of Acquired Immune Deficiency Syndromes
  • Language: English
  • DOI: 10.1097/qai.0000000000001667
  • ISSN: 1525-4135
  • Keywords: Pharmacology (medical) ; Infectious Diseases
  • Origination:
  • Footnote:
  • Description: <jats:sec> <jats:title>Background:</jats:title> <jats:p>Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years of age was 13.2% and CD4 count for those &gt;5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor–based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years.</jats:p> </jats:sec>
  • Access State: Open Access