TY - JOUR
T1 - Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia
AU - TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific
AU - Bartlett, Adam W.
AU - Lumbiganon, Pagakrong
AU - Kurniati, N.
AU - Sudjaritruk, Tavitiya
AU - Mohamed, Thahira J.
AU - Hansudewechakul, R.
AU - Ly, Penh S.
AU - Truong, Khanh H.
AU - Puthanakit, Thanyawee
AU - Nguyen, Lam V.
AU - Chokephaibulkit, Kulkanya
AU - Do, Viet C.
AU - Kumarasamy, N.
AU - Nik Yusoff, Nik Khairulddin
AU - Fong, Moy S.
AU - Watu, Dewi K.
AU - Nallusamy, Revathy
AU - Sohn, Annette H.
AU - Law, Matthew G.
AU - Ly, P. S.
AU - Khol, V.
AU - Tucker, J.
AU - Kumarasamy, N.
AU - Chandrasekaran, E.
AU - Wati, D. K.
AU - Vedaswari, D.
AU - Ramajaya, I. B.
AU - Kurniati, N.
AU - Muktiarti, D.
AU - Fong, S. M.
AU - Lim, M.
AU - Daut, F.
AU - Nik Yusoff, N. K.
AU - Mohamad, P.
AU - Mohamed, T. J.
AU - Drawis, M. R.
AU - Nallusamy, R.
AU - Chan, K. C.
AU - Sudjaritruk, T.
AU - Sirisanthana, V.
AU - Aurpibul, L.
AU - Hansudewechakul, R.
AU - Ounchanum, P.
AU - Denjanta, S.
AU - Kongphonoi, A.
AU - Lumbiganon, P.
AU - Kosalaraksa, P.
AU - Tharnprisan, P.
AU - Udomphanit, T.
AU - Jourdain, G.
N1 - Funding Information:
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 , the Eunice Kennedy Shriver National Institute of Child Health and Human Development , National Cancer Institute , National Institute of Mental Health , and National Institute on Drug Abuse as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, UNSW Australia. A.W.B. received support from an Australian Government Research Training Program Scholarship.
Funding Information:
Conflicts of interest: A.W.B. receives grant support to his institution from Gilead Australia. A.H.S. has received travel and grant support to her institution from ViiV Healthcare. Other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.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, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, National Institute of Mental Health, and National Institute on Drug Abuse as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, UNSW Australia. A.W.B. received support from an Australian Government Research Training Program Scholarship.
Publisher Copyright:
© 2019 Society for Adolescent Health and Medicine
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Purpose: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. Methods: Regional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. Results: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. Conclusions: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.
AB - Purpose: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. Methods: Regional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. Results: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. Conclusions: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.
KW - Adolescent
KW - Antiretroviral therapy
KW - HIV
KW - Monotherapy
KW - Treatment interruption
UR - http://www.scopus.com/inward/record.url?scp=85070102593&partnerID=8YFLogxK
U2 - 10.1016/j.jadohealth.2019.05.025
DO - 10.1016/j.jadohealth.2019.05.025
M3 - Article
AN - SCOPUS:85070102593
SN - 1054-139X
VL - 65
SP - 651
EP - 659
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 5
ER -