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Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

European Pregnancy and Paediatric HIV Cohort Collaboration, Study Group in EuroCoord (2018) Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand. Clin Infect Dis, 66 (4). pp. 594-603. ISSN 1537-6591 https://doi.org/10.1093/cid/cix854
SGUL Authors: Sharland, Michael Roy

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Abstract

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord; Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand, Clinical Infectious Diseases, Volume 66, Issue 4, 1 February 2018, Pages 594–603 is available online at: https://doi.org/10.1093/cid/cix854
Keywords: HIV, antiretroviral therapy, children, second-line, switch, European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord, HIV, children, antiretroviral therapy, second-line, switch, HIV, antiretroviral therapy, children, second-line, switch, 06 Biological Sciences, 11 Medical And Health Sciences, Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Clin Infect Dis
ISSN: 1537-6591
Language: eng
Dates:
DateEvent
1 February 2018Published
26 September 2017Published Online
20 September 2017Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
MC_UU_12023/29Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MC_UU_12023/30Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MC_UU_12023/26Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
260694Seventh Framework Programmehttp://dx.doi.org/10.13039/501100004963
PubMed ID: 29029056
Web of Science ID: WOS:000425383800016
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110390
Publisher's version: https://doi.org/10.1093/cid/cix854

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