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., 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. Advance online publication. https://doi.org/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 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.