Suaysod R. auteur aut IRD Ngo-Giang-Huong Nicole auteur aut IRD Salvadori Nicolas auteur aut IRD Cressey T. R. auteur aut IRD Kanjanavanit S. auteur aut IRD Techakunakorn P. auteur aut IRD Krikajornkitti S. auteur aut IRD Srirojana S. auteur aut IRD Laomanit L. auteur aut IRD Chalermpantmetagul S. auteur aut IRD Lallemant Marc auteur aut IRD Le Coeur S. auteur aut IRD McIntosh K. auteur aut IRD Traisathit P. auteur aut IRD Jourdain Gonzague auteur aut IRD text journalArticle eng text/pdf born digital access 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. specialized antiretroviral therapy failure HIV-infected children protease inhibitor second-line ART genotypic resistance THAILANDE 052 050 61 1 95-101 2015 1058-4838 https://www.documentation.ird.fr/hor/fdi:010064892 10.1093/cid/civ271 1058-4838 [F B010064892] https://www.documentation.ird.fr/hor/fdi:010064892 https://www.documentation.ird.fr/intranet/publi/2015/09/010064892.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2015-10-07 2017-08-23 fdi:010064892 fre