TY - JOUR
T1 - Early and Late Virologic Failure after Virologic Suppression in HIV-Infected Asian Children and Adolescents
AU - TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific
AU - Mu, Weiwei
AU - Bartlett, Adam W.
AU - Bunupuradah, Torsak
AU - Chokephaibulkit, Kulkanya
AU - Kumarasamy, Nagalingeswaran
AU - Ly, Penh Sun
AU - Hansudewechakul, Rawiwan
AU - Nguyen, Lam Van
AU - Lumbiganon, Pagakrong
AU - Sudjaritruk, Tavitiya
AU - Mohamed, Thahira A.Jamal
AU - Yusoff, Nik Khairulddin Nik
AU - Truong, Khanh Huu
AU - Do, Viet Chau
AU - Fong, Moy Siew
AU - Nallusamy, Revathy
AU - Kurniati, Nia
AU - Wati, Dewi Kumara
AU - Sohn, Annette H.
AU - Kariminia, Azar
AU - Zhang, Fujie
N1 - Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Background:Virologic failure is a major threat to maintaining effective combination antiretroviral therapy, especially for children in need of lifelong treatment. With efforts to expand access to HIV viral load testing, our understanding of pediatric virologic failure is evolving.Setting:An Asian cohort in 16 pediatric HIV services across 6 countries.Methods:From 2005 to 2014, patients younger than 20 years who achieved virologic suppression and had subsequent viral load testing were included. Early virologic failure was defined as a HIV RNA ≥1000 copies per milliliter within 12 months of virologic suppression, and late virologic as a HIV RNA ≥1000 copies per milliliter after 12 months following virologic suppression. Characteristics at combination antiretroviral therapy initiation and virologic suppression were described, and a competing risk time-to-event analysis was used to determine cumulative incidence of virologic failure and factors at virologic suppression associated with early and late virologic failure.Results:Of 1105 included in the analysis, 182 (17.9%) experienced virologic failure. The median age at virologic suppression was 6.9 years, and the median time to virologic failure was 24.6 months after virologic suppression. The incidence rate for a first virologic failure event was 3.3 per 100 person-years. Factors at virologic suppression associated with late virologic failure included older age, mostly rural clinic setting, tuberculosis, protease inhibitor-based regimens, and early virologic failure. No risk factors were identified for early virologic failure.Conclusions:Around 1 in 5 experienced virologic failure in our cohort after achieving virologic suppression. Targeted interventions to manage complex treatment scenarios, including adolescents, tuberculosis coinfection, and those with poor virologic control are required.
AB - Background:Virologic failure is a major threat to maintaining effective combination antiretroviral therapy, especially for children in need of lifelong treatment. With efforts to expand access to HIV viral load testing, our understanding of pediatric virologic failure is evolving.Setting:An Asian cohort in 16 pediatric HIV services across 6 countries.Methods:From 2005 to 2014, patients younger than 20 years who achieved virologic suppression and had subsequent viral load testing were included. Early virologic failure was defined as a HIV RNA ≥1000 copies per milliliter within 12 months of virologic suppression, and late virologic as a HIV RNA ≥1000 copies per milliliter after 12 months following virologic suppression. Characteristics at combination antiretroviral therapy initiation and virologic suppression were described, and a competing risk time-to-event analysis was used to determine cumulative incidence of virologic failure and factors at virologic suppression associated with early and late virologic failure.Results:Of 1105 included in the analysis, 182 (17.9%) experienced virologic failure. The median age at virologic suppression was 6.9 years, and the median time to virologic failure was 24.6 months after virologic suppression. The incidence rate for a first virologic failure event was 3.3 per 100 person-years. Factors at virologic suppression associated with late virologic failure included older age, mostly rural clinic setting, tuberculosis, protease inhibitor-based regimens, and early virologic failure. No risk factors were identified for early virologic failure.Conclusions:Around 1 in 5 experienced virologic failure in our cohort after achieving virologic suppression. Targeted interventions to manage complex treatment scenarios, including adolescents, tuberculosis coinfection, and those with poor virologic control are required.
KW - HIV
KW - adolescents
KW - children
KW - virologic failure
UR - http://www.scopus.com/inward/record.url?scp=85061499788&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000001921
DO - 10.1097/QAI.0000000000001921
M3 - Article
C2 - 30531299
AN - SCOPUS:85061499788
SN - 1525-4135
VL - 80
SP - 308
EP - 315
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 3
ER -