Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe

Objectives: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and olde
Objectives: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection.
Methods: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15–29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI.
Results: The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4–111) vs. 8 (IQR 2–38) weeks, respectively], and highest in perinatally infected participants aged 10–14 years [49 (IQR 9–267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0−12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9−5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10–14 years when starting ART (27.7%; 95% CI 13.2−42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10–14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4.
Conclusions: The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.
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Metadaten
Author:Ali Judd, Rebecca Lodwick, Antoni Noguera-Julian, Diana M. Gibb, Karina Butler, Dominique Costagliola, Caroline Sabin, Ard van Sighem, Bruno Ledergerber, Carlo Torti, Amanda Mocroft, Daniel Podzamczer, Maria Dorrucci, Stephane de Wit, Niels Obel, Francois Dabis, Alessandro Cozzi-Lepri, Federico Garcia, Norbert H. Brockmeyer, Josiane Warszawski, María Isabel González Tomé, Cristina Mussini, Giota Touloumi, Robert Zangerle, Jade Ghosn, Antonella Castagna, Gerd Fätkenheuer, Christoph Stephan, Laurence Meyer, Maria Athena Campbell, Geneviève Chêne, Andrew Phillips
URN:urn:nbn:de:hebis:30:3-439614
DOI:http://dx.doi.org/10.1111/hiv.12411
ISSN:1468-1293
ISSN:1464-2662
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=27625109
Parent Title (English):HIV medicine
Publisher:Wiley-Blackwell
Place of publication:Oxford [u. a.]
Document Type:Article
Language:English
Date of Publication (online):2017/08/21
Year of first Publication:2016
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Contributing Corporation:The Pursuing Later Treatment Options II (PLATO II) Project Team for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord
Release Date:2017/08/21
Tag:Europe; perinatal HIV infection; virological failure; young people
Volume:18
Issue:3
Pagenumber:10
First Page:171
Last Page:180
Note:
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
HeBIS PPN:428608922
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0

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