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Time to switch to second-line antiretroviral therapy in children with human immunodeficiency virus in Europe and Thailand

Lookup NU author(s): Dr Terence Flood


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© The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. Background. Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods. Children aged <18 years initiating combination ART (.2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of .1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results. Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%.23%), with significant regional variations. Median time to switch was 30 (IQR, 16.58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions. One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.

Publication metadata

Author(s): Goetghebuer T, Hainaut M, Van Der Kelen E, Delforge M, Warszawski J, Le Chenadec J, Ramos E, Dialla O, Wack T, Laurent C, Selmi LA, Leymarie I, Benali FA, Brossard M, Boufassa L, Floch-Tudal C, Firtion G, Hau I, Chace A, Bolot P, Blanche S, Granier M, Labrune P, Lachassine E, Dollfus C, Levine M, Fourcade C, Heller-Roussin B, Runel-Belliard C, Tricoire J, Monpoux F, Chirouze C, Reliquet V, Brouard J, Kebaili K, Fialaire P, Lalande M, Mazingue F, Partisani ML, Konigs C, Schultze-Strasser S, Baumann U, Niehues T, Neubert J, Kobbe R, Feiterna-Sperling C, Konigs C, Buchholz B, Notheis G, Naver L, Soeria-Atmadja S, Hagas V, Scott S, Vaughan Y, Welch S, Laycock N, Bernatoniene J, Finn A, Hutchison L, Sharpe G, Williams A, Lyall EGH, Seery P, Lewis P, Miles K, Subramaniam B, Hutchinson L, Ward P, Sloper K, Gopal G, Doherty C, Hague R, Price V, Bamford A, Bundy H, Clapson M, Flynn J, Gibb DM, Klein N, Novelli V, Shingadia D, Ainsley-Walker P, Tovey P, Gurtin D, Garside JP, Fall A, Porter D, Segal S, Ball C, Hawkins S, Chetcuti P, Dowie M, Bandi S, McCabe A, Eisenhut M, Handforth J, Roy PK, Flood T, Pickering A, Liebeschuetz S, Kavanagh C, Murphy C, Rowson K, Tan T, Daniels J, Lees Y, Kerr E, Thompson F, Williams A, Le Provost M, Cliffe L, Smyth A, Stafford S, Freeman A, Reddy T, Fidler K, Christie S, Gordon A, Rogahn D, Harris S, Hutchinson L, Collinson A, Hutchinson L, Jones L, Offerman B, Van Someren V, Benson C, Riordan A, Riddell A, O'Connor R, Brown N, Ibberson L, Shackley F, Faust SN, Hancock J, Doerholt K, Donaghy S, Prime K, Sharland M, Storey S, Gorman S, Lyall EGH, Monrose C, Seery P, Tudor-Williams G, Walters S, Cross R, Menson E, Broomhall J, Hutchinson L, Scott D, Stroobant J, Bridgwood A, McMaster P, Evans J, Gardiner T, Jones R, Gardiner K

Publication type: Article

Publication status: Published

Journal: Clinical Infectious Diseases

Year: 2018

Volume: 66

Issue: 4

Pages: 594-603

Print publication date: 01/02/2018

Online publication date: 26/09/2017

Acceptance date: 20/09/2017

ISSN (print): 1058-4838

ISSN (electronic): 1537-6591

Publisher: Oxford University Press


DOI: 10.1093/cid/cix854


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