Article approval pendingWith expanding pediatric antiretroviral therapy (ART) access, children will begin to experience treatment failure and require second-line therapy. We evaluated the probability and determinants of virologic failure and switching in children in South Africa

Boulle, Andrew

Davies, Mary-Ann

Egger, Matthias

Eley, Brian

Giddy, Janet

Keiser, Olivia

Moultrie, Harry

Rabie, Helena

Technau, Karl

Van Cutsem, Gilles

Wood, Robin

English

PubMed

MSF Field Research

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Virologic failure and second-line antiretroviral therapy in children in South Africa--the IeDEA Southern Africa collaboration

Mary-Ann Davies

Harry Moultrie

Brian Eley

Helena Rabie

Gilles Van Cutsem

Janet Giddy

Robin Wood

Karl Technau

Olivia Keiser

Matthias Egger

Andrew Boulle

Crossref

JAIDS Journal of Acquired Immune Deficiency Syndromes

Virologic Failure and Second-Line Antiretroviral Therapy in Children in South Africa—The IeDEA Southern Africa Collaboration

Background: With expanding pediatric antiretroviral therapy (ART) access, children will begin to experience treatment failure and require second-line therapy. We evaluated the probability and determinants of virologic failure and switching in children in South Africa.



Methods: Pooled analysis of routine individual data from children who initiated ART in 7 South African treatment programs with 6-monthly viral load and CD4 monitoring produced Kaplan-Meier estimates of probability of virologic failure (2 consecutive unsuppressed viral loads with the second being >1000 copies/mL, after ≥24 weeks of therapy) and switch to second-line. Cox-proportional hazards models stratified by program were used to determine predictors of these outcomes.



Results: The 3-year probability of virologic failure among 5485 children was 19.3% (95% confidence interval: 17.6 to 21.1). Use of nevirapine or ritonavir alone in the initial regimen (compared with efavirenz) and exposure to prevention of mother to child transmission regimens were independently associated with failure [adjusted hazard ratios (95% confidence interval): 1.77 (1.11 to 2.83), 2.39 (1.57 to 3.64) and 1.40 (1.02 to 1.92), respectively]. Among 252 children with ≥1 year follow-up after failure, 38% were switched to second-line. Median (interquartile range) months between failure and switch was 5.7 (2.9-11.0).



Conclusions: Triple ART based on nevirapine or ritonavir as a single protease inhibitor seems to be associated with a higher risk of virologic failure. A low proportion of virologically failing children were switched

BORIS Portal  Bern Open Repository and Information System

Background: With expanding pediatric antiretroviral therapy (ART) access, children will begin to experience treatment failure and require second-line therapy. We evaluated the probability and determinants of virologic failure and switching in children in South Africa. Methods: Pooled analysis of routine individual data from children who initiated ART in 7 South African treatment programs with 6-monthly viral load and CD4 monitoring produced Kaplan-Meier estimates of probability of virologic failure (2 consecutive unsuppressed viral loads with the second being >1000 copies/mL, after 24 weeks of therapy) and switch to second-line. Cox-proportional hazards models stratified by program were used to determine predictors of these outcomes. Results: The 3-year probability of virologic failure among 5485 children was 19.3% (95% confidence interval: 17.6 to 21.1). Use of nevirapine or ritonavir alone in the initial regimen (compared with efavirenz) and exposure to prevention of mother to child transmission regimens were independently associated with failure [adjusted hazard ratios (95% confidence interval): 1.77 (1.11 to 2.83), 2.39 (1.57 to 3.64) and 1.40 (1.02 to 1.92), respectively]. Among 252 children with 1 year follow-up after failure, 38% were switched to second-line. Median (interquartile range) months between failure and switch was 5.7 (2.9-11.0). Conclusions: Triple ART based on nevirapine or ritonavir as a single protease inhibitor seems to be associated with a higher risk of virologic failure. A low proportion of virologically failing children were switched. Copyright © 2011 by Lippincott Williams & Wilkins.Articl

Davies M.-A.

Moultrie H.

Eley B.

Rabie H.

Van Cutsem G.

Giddy J.

Wood R.

Technau K.

Keiser O.

Egger M.

Boulle A.

Stellenbosch University SUNScholar Repository

Virologic failure and second-line antiretroviral therapy in children in South Africa-the IeDEA Southern Africa collaboration

http://boris.unibe.ch/7318/7/Davies%20JAIDS%202011_manuscript.pdf

Virologic failure and second-line antiretroviral therapy in children in South Africa--the IeDEA Southern Africa collaboration

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Stellenbosch University SUNScholar Repository