TY - JOUR
T1 - Short Communication
T2 - Impact of Viral Load Use on Treatment Switch in Perinatally HIV-Infected Children in Asia
AU - Jamal Mohamed, Thahira
AU - Teeraananchai, Sirinya
AU - Kerr, Stephen
AU - Phongsamart, Wanatpreeya
AU - Nik Yusoff, Nik Khairulddin
AU - Hansudewechakul, Rawiwan
AU - Ly, Penh Sun
AU - Nguyen, Lam Van
AU - Sudjaritruk, Tavitiya
AU - Lumbiganon, Pagakrong
AU - Do, Viet Chau
AU - Kurniati, Nia
AU - Kumarasamy, Nagalingeswaran
AU - Wati, Dewi Kumara
AU - Fong, Moy Siew
AU - Nallusamy, Revathy
AU - Kariminia, Azar
AU - Sohn, Annette H.
N1 - Funding Information:
Acknowledgments The TREAT Asia Pediatric HIV Observational Database is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Cancer Institute as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907), and the AIDS Life Association. The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and it is affiliated with the Faculty of Medicine, The University of New South Wales. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned earlier.
Publisher Copyright:
© 2017, Mary Ann Liebert, Inc. 2017.
PY - 2017/3
Y1 - 2017/3
N2 - We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.
AB - We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.
KW - HIV
KW - antiretroviral therapy
KW - molecular virology
UR - http://www.scopus.com/inward/record.url?scp=85014491256&partnerID=8YFLogxK
U2 - 10.1089/aid.2016.0039
DO - 10.1089/aid.2016.0039
M3 - Article
C2 - 27758114
AN - SCOPUS:85014491256
SN - 0889-2229
VL - 33
SP - 230
EP - 233
JO - AIDS Research and Human Retroviruses
JF - AIDS Research and Human Retroviruses
IS - 3
ER -