Identification, Management, and Outcomes of Combination Antiretroviral Treatment Failure in Adolescents With Perinatal Human Immunodeficiency Virus Infection in Asia

Adam W. Bartlett, Tavitiya Sudjaritruk, Thahira J. Mohamed, Suvaporn Anugulruengkit, Nagalingeswaran Kumarasamy, Wanatpreeya Phongsamart, Penh Sun Ly, Khanh Huu Truong, Lam Van Nguyen, Viet Chau Do, Pradthana Ounchanum, Thanyawee Puthanakit, Kulkanya Chokephaibulkit, Pagakrong Lumbiganon, Nia Kurniati, Nik Khairulddin Nik Yusoff, Dewi Kumara Wati, Annette H. Sohn, Azar Kariminia

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Combination antiretroviral therapy (cART) failure is a major threat to human immunodeficiency virus (HIV) programs, with implications for individual- and population-level outcomes. Adolescents with perinatally acquired HIV infection (PHIVA) should be a focus for treatment failure given their poorer outcomes compared to children and adults. METHODS: Data (2014-2018) from a regional cohort of Asian PHIVA who received at least 6 months of continuous cART were analyzed. Treatment failure was defined according to World Health Organization criteria. Descriptive analyses were used to report treatment failure and subsequent management and evaluate postfailure CD4 count and viral load trends. Kaplan-Meier survival analyses were used to compare the cumulative incidence of death and loss to follow-up (LTFU) by treatment failure status. RESULTS: A total 3196 PHIVA were included in the analysis with a median follow-up period of 3.0 years, of whom 230 (7.2%) had experienced 292 treatment failure events (161 virologic, 128 immunologic, 11 clinical) at a rate of 3.78 per 100 person-years. Of the 292 treatment failure events, 31 (10.6%) had a subsequent cART switch within 6 months, which resulted in better immunologic and virologic outcomes compared to those who did not switch cART. The 5-year cumulative incidence of death and LTFU following treatment failure was 18.5% compared to 10.1% without treatment failure. CONCLUSIONS: Improved implementation of virologic monitoring is required to realize the benefits of virologic determination of cART failure. There is a need to address issues related to accessibility to subsequent cART regimens, poor adherence limiting scope to switch regimens, and the role of antiretroviral resistance testing.
Original languageEnglish
Pages (from-to)e1919-e1926
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume73
Issue number7
DOIs
Publication statusPublished - 5 Oct 2021

Keywords

  • adolescent
  • antiretroviral therapy
  • HIV
  • treatment failure

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