Affiliations 

  • 1 1 Pediatric Institute , Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 2 2 HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok, Thailand
  • 3 3 Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
  • 4 4 Hospital Raja Perempuan Zainab II , Kelantan, Malaysia
  • 5 5 Chiangrai Prachanukroh Hospital , Chiang Rai, Thailand
  • 6 6 National Centre for HIV/AIDS , Dermatology and STDs, Phnom Penh, Cambodia
  • 7 7 National Hospital of Pediatrics , Hanoi, Vietnam
  • 8 8 Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University , Chiang Mai, Thailand
  • 9 9 Department of Pediatrics, Khon Kaen University , Khon Kaen, Thailand
  • 10 10 Children's Hospital 2 , Ho Chi Minh City, Vietnam
  • 11 11 Cipto Mangunkusumo General Hospital , Jakarta, Indonesia
  • 12 12 YRGCARE Medical Centre , CART CRS, Chennai, India
  • 13 13 Sanglah Hospital, Udayana University , Bali, Indonesia
  • 14 14 Hospital Likas , Kota Kinabalu, Malaysia
  • 15 15 Penang Hospital , Penang, Malaysia
  • 16 16 The Kirby Institute , UNSW Australia, Sydney, Australia
  • 17 17 TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok, Thailand
AIDS Res. Hum. Retroviruses, 2017 03;33(3):230-233.
PMID: 27758114 DOI: 10.1089/AID.2016.0039

Abstract

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.

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