Identification, Management, and Outcomes of Combination Antiretroviral Treatment Failure in Adolescents With Perinatal Human Immunodeficiency Virus Infection in Asia
| Autor: | Thahira Jamal Mohamed, Adam W. Bartlett, Lam Van Nguyen, Viet Chau Do, Tavitiya Sudjaritruk, Azar Kariminia, Khanh Huu Truong, Pagakrong Lumbiganon, Wanatpreeya Phongsamart, Pradthana Ounchanum, Nia Kurniati, Nik Khairulddin Nik Yusoff, Penh Sun Ly, Annette H. Sohn, Nagalingeswaran Kumarasamy, Thanyawee Puthanakit, Kulkanya Chokephaibulkit, Suvaporn Anugulruengkit, Dewi Kumara Wati |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
0301 basic medicine Microbiology (medical) Cart Pediatrics medicine.medical_specialty Asia Adolescent Anti-HIV Agents Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Treatment failure 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Antiretroviral treatment Humans Cumulative incidence Treatment Failure 030212 general & internal medicine Child Online Only Articles business.industry Viral Load 030112 virology Antiretroviral therapy CD4 Lymphocyte Count Infectious Diseases Cohort Female business Viral load |
| Zdroj: | Clin Infect Dis |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciaa872 |
| Popis: | Background Combination antiretroviral therapy (cART) failure is a major threat to human immunodeficiency virus (HIV) programs, with implications for individual- and population-level outcomes. Adolescents with perinatally acquired HIV infection (PHIVA) should be a focus for treatment failure given their poorer outcomes compared to children and adults. Methods Data (2014–2018) from a regional cohort of Asian PHIVA who received at least 6 months of continuous cART were analyzed. Treatment failure was defined according to World Health Organization criteria. Descriptive analyses were used to report treatment failure and subsequent management and evaluate postfailure CD4 count and viral load trends. Kaplan-Meier survival analyses were used to compare the cumulative incidence of death and loss to follow-up (LTFU) by treatment failure status. Results A total 3196 PHIVA were included in the analysis with a median follow-up period of 3.0 years, of whom 230 (7.2%) had experienced 292 treatment failure events (161 virologic, 128 immunologic, 11 clinical) at a rate of 3.78 per 100 person-years. Of the 292 treatment failure events, 31 (10.6%) had a subsequent cART switch within 6 months, which resulted in better immunologic and virologic outcomes compared to those who did not switch cART. The 5-year cumulative incidence of death and LTFU following treatment failure was 18.5% compared to 10.1% without treatment failure. Conclusions Improved implementation of virologic monitoring is required to realize the benefits of virologic determination of cART failure. There is a need to address issues related to accessibility to subsequent cART regimens, poor adherence limiting scope to switch regimens, and the role of antiretroviral resistance testing. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|