TY  - JOUR
A1  - Judd, Ali
A1  - Lodwick, Rebecca
A1  - Noguera-Julian, Antoni
A1  - Gibb, Diana M.
A1  - Butler, Karina
A1  - Costagliola, Dominique
A1  - Sabin, Caroline
A1  - Sighem, Ard van
A1  - Ledergerber, Bruno
A1  - Torti, Carlo
A1  - Mocroft, Amanda
A1  - Podzamczer, Daniel
A1  - Dorrucci, Maria
A1  - Wit, Stephane de
A1  - Obel, Niels
A1  - Dabis, Francois
A1  - Cozzi-Lepri, Alessandro
A1  - Garcia, Federico
A1  - Brockmeyer, Norbert H.
A1  - Warszawski, Josiane
A1  - González Tomé, María Isabel
A1  - Mussini, Cristina
A1  - Touloumi, Giota
A1  - Zangerle, Robert
A1  - Ghosn, Jade
A1  - Castagna, Antonella
A1  - Fätkenheuer, Gerd
A1  - Stephan, Christoph
A1  - Meyer, Laurence
A1  - Campbell, Maria Athena
A1  - Chêne, Geneviève
A1  - Phillips, Andrew
T1  - Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe
T2  - HIV medicine
N2  - 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.
KW  - Europe
KW  - perinatal HIV infection
KW  - virological failure
KW  - young people
Y1  - 2017
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/43961
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-439614
SN  - 1468-1293
SN  - 1464-2662
N1  - 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.
VL  - 18
IS  - 3
SP  - 171
EP  - 180
PB  - Wiley-Blackwell
CY  - Oxford [u. a.]
ER  -