• 1 Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 2 The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
  • 3 HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 4 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 5 YRGCARE Medical Centre, CART CRS, Chennai, India
  • 6 National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 7 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 8 National Hospital of Pediatrics, Hanoi, Vietnam
  • 9 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 10 Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 11 Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 12 Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
  • 13 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 14 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 15 Hospital Likas, Kota Kinabalu, Malaysia
  • 16 Penang Hospital, Penang, Malaysia
  • 17 Cipto Mangunkusumo-Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • 18 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 19 TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand
J Acquir Immune Defic Syndr, 2019 03 01;80(3):308-315.
PMID: 30531299 DOI: 10.1097/QAI.0000000000001921


BACKGROUND: Virologic failure is a major threat to maintaining effective combination antiretroviral therapy, especially for children in need of lifelong treatment. With efforts to expand access to HIV viral load testing, our understanding of pediatric virologic failure is evolving.

SETTING: An Asian cohort in 16 pediatric HIV services across 6 countries.

METHODS: From 2005 to 2014, patients younger than 20 years who achieved virologic suppression and had subsequent viral load testing were included. Early virologic failure was defined as a HIV RNA ≥1000 copies per milliliter within 12 months of virologic suppression, and late virologic as a HIV RNA ≥1000 copies per milliliter after 12 months following virologic suppression. Characteristics at combination antiretroviral therapy initiation and virologic suppression were described, and a competing risk time-to-event analysis was used to determine cumulative incidence of virologic failure and factors at virologic suppression associated with early and late virologic failure.

RESULTS: Of 1105 included in the analysis, 182 (17.9%) experienced virologic failure. The median age at virologic suppression was 6.9 years, and the median time to virologic failure was 24.6 months after virologic suppression. The incidence rate for a first virologic failure event was 3.3 per 100 person-years. Factors at virologic suppression associated with late virologic failure included older age, mostly rural clinic setting, tuberculosis, protease inhibitor-based regimens, and early virologic failure. No risk factors were identified for early virologic failure.

CONCLUSIONS: Around 1 in 5 experienced virologic failure in our cohort after achieving virologic suppression. Targeted interventions to manage complex treatment scenarios, including adolescents, tuberculosis coinfection, and those with poor virologic control are required.

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