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Home >> Publications >> Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia.

Publication

Author(s):

Boettiger DC1, Sudjaritruk T2, Nallusamy R3, Lumbiganon P4, Rungmaitree S5, Hansudewechakul R6, Kumarasamy N7, Bunupuradah T8, Saphonn V9, Truong KH10, Yusoff NK11, Do VC12, Nguyen LV13, Razali KA14, Fong SM15, Kurniati N16, Kariminia A17.

Pub Title:

Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia.

Pub Date:

Apr 1 2016

Pub Region(s):

Asia-Pacific

Journal:

Title: 
J Adolesc Health

PubMed: 26803201
Pub PDF:

PURPOSE: About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population.

METHODS: Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL.

RESULTS: Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm(3). The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count ≤200 cells/mm(3) (HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure.

CONCLUSIONS: Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.

 

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Citation:

J Adolesc Health. 2016 Apr;58(4):451-9. doi: 10.1016/j.jadohealth.2015.11.006. Epub 2016 Jan 20. Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia. Boettiger DC1, Sudjaritruk T2, Nallusamy R3, Lumbiganon P4, Rungmaitree S5, Hansudewechakul R6, Kumarasamy N7, Bunupuradah T8, Saphonn V9, Truong KH10, Yusoff NK11, Do VC12, Nguyen LV13, Razali KA14, Fong SM15, Kurniati N16, Kariminia A17.