%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Suaysod, R.
%A Ngo-Giang-Huong, Nicole
%A Salvadori, Nicolas
%A Cressey, T. R.
%A Kanjanavanit, S.
%A Techakunakorn, P.
%A Krikajornkitti, S.
%A Srirojana, S.
%A Laomanit, L.
%A Chalermpantmetagul, S.
%A Lallemant, Marc
%A Le Coeur, S.
%A McIntosh, K.
%A Traisathit, P.
%A Jourdain, Gonzague
%T Treatment failure in HIV-infected children on second-line protease inhibitor-based antiretroviral therapy
%D 2015
%L fdi:010064892
%G ENG
%J Clinical Infectious Diseases
%@ 1058-4838
%K antiretroviral therapy failure ; HIV-infected children ; protease inhibitor ; second-line ART ; genotypic resistance
%K THAILANDE
%M ISI:000359323500016
%N 1
%P 95-101
%R 10.1093/cid/civ271
%U https://www.documentation.ird.fr/hor/fdi:010064892
%> https://www.documentation.ird.fr/intranet/publi/2015/09/010064892.pdf
%V 61
%W Horizon (IRD)
%X Background. Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure. Methods. HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure. Results. A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age > 13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001). Conclusions. Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored.
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