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Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland

Duong, Trinh; Judd, Ali; Collins, Intira Jeannie; Doerholt, Katja; Lyall, Hermione; Foster, Caroline; Butler, Karina; Tookey, Pat; Shingadia, Delane; Menson, Esse; Dunn, David T.; Gibb, Di M.; Smyth, Alan R.

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Authors

Trinh Duong

Ali Judd

Intira Jeannie Collins

Katja Doerholt

Hermione Lyall

Caroline Foster

Karina Butler

Pat Tookey

Delane Shingadia

Esse Menson

David T. Dunn

Di M. Gibb

Alan R. Smyth



Abstract

Objective: To assess factors at the start of antiretroviral therapy (ART) associated with long-term virological response in children.
Design: Multicentre national cohort.
Methods: Factors associated with viral load below 400 copies/ml by 12 months and virologic failure among children starting 3/4-drug ART in the UK/Irish Collaborative HIV Paediatric Study were assessed using Poisson models.
Results: Nine hundred and ninety-seven children started ART at a median age of 7.7 years (inter-quartile range 2.9–11.7), 251 (25%) below 3 years: 411 (41%) with efavirenz and two nucleoside reverse transcriptase inhibitors (EFVþ2NRTIs), 264 (26%) with nevirapine and two NRTIs (NVPþ2NRTIs), 119 (12%; 106 NVP, 13 EFV) with non-nucleoside reverse transcriptase inhibitor and three NRTIs (NNRTIþ3NRTIs), and 203 (20%) with boosted protease inhibitor-based regimens. Median follow-up after ART initiation was 5.7 (3.0–8.8) years. Viral load was less than 400 copies/ml by 12 months in 92% [95% confidence interval (CI) 91–94%] of the children. Time to suppression was similar across regimens (P¼0.10), but faster over calendar time, with older age and lower baseline viral load. Three hundred and thirtynine (34%) children experienced virological failure. Although progression to failure varied by regimen (P<0.001) and was fastest for NVPþ2NRTIs regimens, risk after 2 years on therapy was similar for EFVþ2NRTIs and NVPþ2NRTIs, and lowest for NNRTIþ3NRTIs regimens (P-interaction¼0.03). Older age, earlier calendar periods and maternal ART exposure were associated with increased failure risk. Early treatment discontinuation for toxicity occurred more frequently for NVP-based regimens, but 5-year cumulative incidence was similar: 6.1% (95% CI 3.9–8.9%) NVP, 8.3% (95% CI 5.6–11.6) EFV, and 9.8% (95% CI 5.7–15.3%) protease inhibitor-based regimens (P¼0.48).
Conclusion: Viral load suppression by 12 months was high with all regimens. NVPþ3NRTIs regimens were particularly efficacious in the longer term and may be a good alternative to protease inhibitor-based ART in young children.

Citation

Duong, T., Judd, A., Collins, I. J., Doerholt, K., Lyall, H., Foster, C., Butler, K., Tookey, P., Shingadia, D., Menson, E., Dunn, D. T., Gibb, D. M., & Smyth, A. R. (2014). Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland. AIDS, 28(16), https://doi.org/10.1097/QAD.0000000000000438

Journal Article Type Article
Publication Date Oct 23, 2014
Deposit Date Feb 15, 2016
Publicly Available Date Feb 15, 2016
Journal AIDS
Print ISSN 0269-9370
Electronic ISSN 1473-5571
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 28
Issue 16
DOI https://doi.org/10.1097/QAD.0000000000000438
Keywords antiretroviral therapy, children, HIV, UK/Ireland, virological outcome
Public URL https://nottingham-repository.worktribe.com/output/737706
Publisher URL http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2014&issue=10230&article=00008&type=abstract

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