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Home >> Publications >> Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation.

Publication

Author(s):

Desmonde S, Eboua FT, Malateste K, Dicko F, Ekouévi DK, Ngbeché S, Koueta F, Sy HS, Renner L, Koumakpai SA, Leroy V; IeDEA Pediatric West African Working Group.

Pub Title:

Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation.

Pub Date:

Feb 2 2016

Pub Region(s):

West Africa

Page Number:
1527-36

Journal:

Title: 
AIDS
Link: 
http://ovidsp.tx.ovid.com/sp-3.18.0b/ovidweb.cgi?QS2=434f4e1a73d37e8c8b3eab7e2fc8fd7c5f3bb03165fcc028634b0fc7d81ec4caae31ee203a49b163fa3867fd2869ba3358db42307d5384f040a13d0e1a5a0ee6afb20f555e2e4779c91df82ed21a3281a890eb6bcc89523039359ffbb824e701b0f026c8ce

PubMed: 26244392

BACKGROUND:

We described reasons for switching to second-line antiretroviral treatment (ART) and time to switch in HIV-infected children failing first-line ART in West Africa.

METHODS:

We included all children aged 15 years or less, starting ART (at least three drugs) in the paediatric IeDEA clinical centres in five West-African countries. We estimated the incidence of switch (at least one a drug class change) within 24 months of ART and associated factors were identified in a multinomial logistic regression. Among children with clinical-immunological failure, we estimated the 24-month probability of switching to a second-line and associated factors, using competing risks. Children who switched to second-line ART following the withdrawal of nelfinavir in 2007 were excluded.

RESULTS:

Overall, 2820 children initiated ART at a median age of 5 years; 144 (5%) were on nelfinavir. At 24-month post-ART initiation, 188 (7%) had switched to second-line. The most frequent reasons were drug stock outs (20%), toxicity (18%), treatment failure (16%) and poor adherence (8%). Over the 24-month follow-up period, 322 (12%) children failed first-line ART after a median time of 7 months. Of these children, 21 (7%) switched to second-line after a median time of 21 weeks in failure. This was associated with older age [subdistribution hazard ratio (sHR) 1.21, 95% confidence interval (95% CI) 1.10-1.33] and longer time on ART (sHR 1.16, 95% CI 1.07-1.25).

CONCLUSION:

Switches for clinical failure were rare and switches after an immunological failure were insufficient. These gaps reveal that it is crucial to advocate for both sustainable access to first-line and alternative regimens to provide adequate roll-out of paediatric ART programmes

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Citation:

Desmonde S, Eboua FT, Malateste K, Dicko F, Ekouévi DK, Ngbeché S, Koueta F, Sy HS, Renner L, Koumakpai SA, et al. Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation. AIDS. 2015 Jul 31;29(12):1527-36. doi: 10.1097/QAD.0000000000000707. PubMed PMID: 26244392.