Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort
Year: 2018
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. METHODS: Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. RESULTS: In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years of age was 13.2% and CD4 count for those >5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor-based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively. CONCLUSIONS: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years.
Authors: Kara Wools-Kaloustian, Irene Marete, Samuel Ayaya, Annette H. Sohn, Lam Van Nguyen, Shanshan Li, Valériane Leroy, Beverly S. Musick, Jamie E. Newman, Andrew Edmonds, Mary-Ann Davies, François T. Eboua, Marie-Thérèse Obama, Marcel Yotebieng, Shobna Sawry, Lynne M. Mofenson, Constantin T. Yiannoutsos
Institutions: Indiana University School of Medicine, Moi University, Vietnam National Children's Hospital, Université Toulouse III - Paul Sabatier, Inserm, RTI International, University of North Carolina at Chapel Hill, University of Cape Town, Centre Hospitalier Universitaire de Yopougon, University Teaching Hospital of Yaounde, The Ohio State University, University of the Witwatersrand, Elizabeth Glaser Pediatric AIDS Foundation
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: amfAR, The Foundation for AIDS Research, Institut de Recherche pour le Développement, Universitas Udayana, University of New South Wales, Chiang Mai University, Chulalongkorn University, Khon Kaen University, Mahidol University, Universitas Indonesia, National Institutes of Health, Faculty of Medicine, Chiang Mai University, Faculty of Medicine Siriraj Hospital, Mahidol University, Fakultas Kedokteran, Universitas Indonesia, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G2149172187, G2746664592, G6221361229, International Epi Databases to Evaluate AIDS (IEDEA) in central Africa (Region 9), IeDEA Asia-Pacific Research Collaboration, Central Africa International Epidemiology databases to Evaluate AIDS, East Africa International Epidemiology Database to evaluate AIDS (IeDEA) Regional Consortium, International Epidemiology Databases to EvaluateAIDS (IeDEA) Renewal 4, International epidemiology Databases to Evaluate AIDS (IeDEA) Southern Africa.
OpenAlex ID: W2793592425