Time to switch to second-line antiretroviral therapy in children with human immunodeficiency virus in Europe and Thailand

• Verfasst von: Goetghebuer, Tessa [VerfasserIn]
• Verfasst von: Buchholz, Bernd [VerfasserIn]
• Titel: Time to switch to second-line antiretroviral therapy in children with human immunodeficiency virus in Europe and Thailand
• Verf.angabe: The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord
• Jahr: 2018
• Jahr des Originals: 2017
• Umfang: 10 S.
• Fussnoten: Gesehen am 08.10.2019 ; The members of the project team and writing group are listed in the notes ; Published online September 26, 2017
• Titel Quelle: Enthalten in: Clinical infectious diseases
• Ort Quelle: Oxford : Oxford Journals, 1992
• Jahr Quelle: 2018
• Band/Heft Quelle: 66(2018), 4, Seite 594-603
• ISSN Quelle: 1537-6591
• DOI: doi:10.1093/cid/cix854
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 167847150X

Abstract

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.