Affiliations 

  • 1 Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia. Electronic address: dboettiger@kirby.unsw.edu.au
  • 2 Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 3 Department of Pediatrics, Penang Hospital, Malaysia
  • 4 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 5 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 6 Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 7 YRG CARE Medical Centre, CART CRS, Chennai, India
  • 8 HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 9 National Centre for HIV/AIDS Dermatology and STDs, University of Health Sciences, Phnom Penh, Cambodia
  • 10 Department of Infectious Diseases, Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 11 Department of Pediatrics, Hospital Raja Perempuan Zainab II, Malaysia
  • 12 Department of Infectious Diseases, Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 13 National Hospital of Pediatrics, Hanoi, Vietnam
  • 14 Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 15 Hospital Likas, Kota Kinabalu, Malaysia
  • 16 Department of Child Health, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 17 Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
J Adolesc Health, 2016 Apr;58(4):451-459.
PMID: 26803201 DOI: 10.1016/j.jadohealth.2015.11.006

Abstract

PURPOSE: About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population.

METHODS: Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL.

RESULTS: Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm(3). The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count ≤200 cells/mm(3) (HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure.

CONCLUSIONS: Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.