Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

Kara Wools-Kaloustian, Irene Marete, Samuel Ayaya, Annette H. Sohn, Lam Van Nguyen, Shanshan Li, Valériane Leroy, Beverly S. Musick, Jamie E. Newman, Andrew Edmonds, Mary Ann Davies, François T. Eboua, Marie Thérèse Obama, Marcel Yotebieng, Shobna Sawry, Lynne M. Mofenson, Constantin T. Yiannoutsos

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

BACKGROUND: Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. METHODS: Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. RESULTS: In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years of age was 13.2% and CD4 count for those >5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor-based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively. CONCLUSIONS: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years.

Original languageEnglish (US)
Pages (from-to)221-230
Number of pages10
JournalJournal of acquired immune deficiency syndromes (1999)
Volume78
Issue number2
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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    Wools-Kaloustian, K., Marete, I., Ayaya, S., Sohn, A. H., Van Nguyen, L., Li, S., Leroy, V., Musick, B. S., Newman, J. E., Edmonds, A., Davies, M. A., Eboua, F. T., Obama, M. T., Yotebieng, M., Sawry, S., Mofenson, L. M., & Yiannoutsos, C. T. (2018). Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort. Journal of acquired immune deficiency syndromes (1999), 78(2), 221-230. https://doi.org/10.1097/QAI.0000000000001667