Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia

• Main Authors: David C. Boettiger, Tavitiya Sudjaritruk, Revathy Nallusamy, Pagakrong Lumbiganon, Supattra Rungmaitree, Rawiwan Hansudewechakul, Nagalingeswaran Kumarasamy, Torsak Bunupuradah, Vonthanak Saphonn, Khanh Huu Truong, Nik K.N. Yusoff, Viet Chau Do, Lam V. Nguyen, Kamarul A.M. Razali, Siew Moy Fong, Nia Kurniati, Azar Kariminia
• Format: Journal
• Published: 2018
• Subjects: Medicine
• Online Access: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84955237815&origin=inward; http://cmuir.cmu.ac.th/jspui/handle/6653943832/56175
• Institution: Chiang Mai University

© 2016 Society for Adolescent Health and Medicine. All rights reserved. Purpose About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population. Methods Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL. Results Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm3. The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p =.05). Baseline CD4+ count ≤200 cells/mm3(HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p =.02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p =.05) were both associated with clinical failure. Conclusions Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.