Time to first-line art failure and time to second-line art switch in the IeDEA pediatric cohort
Wools-Kaloustian, K., Marete, I., Ayaya, S., Sohn, A. H., Van Nguyen, L., Li, S., ... 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. DOI: 10.1097/QAI.0000000000001667
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 2-14 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 [LTP]). 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 was 13.2% and CD4 count for those >5 years was 258 cells/µl. Almost all (94.4%) initiated a non-nucleoside reverse transcriptase inhibitor (NNRTI); 5.3% a protease inhibitor (PI), and 0.3% a triple nucleoside (NRTI)-based regimen. At one year, 7.7% had failed and 14.4% had experienced attrition; by five years, the cumulative incidence was 25.9% and 29.4%, respectively. At one year after ART failure, 13.7% had transitioned to second-line and 11.2% had experience attrition; by five 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 five years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within five years.