Second-line protease inhibitor-based HAART after failing non-nucleoside reverse transcriptase inhibitorbased regimens in Asian HIV-infected children

• Main Authors: Torsak Bunupuradah, Thanyawee Puthanakit, Paul Fahey, Azar Kariminia, Nik K.N. Yusoff, Truong H. Khanh, Annette H. Sohn, Kulkanya Chokephaibulkit, Pagakrong Lumbiganon, Rawiwan Hansudewechakul, Kamarul Razali, Nia Kurniati, Bui V. Huy, Tavitiya Sudjaritruk, Nagalingeswaran Kumarasamy, Siew M. Fong, Vonthanak Saphonn, Jintanat Ananworanich
• Other Authors: The HIV Netherlands Australia Thailand Research Collaboration
• Format: Article
• Published: 2018
• Subjects: Medicine; Pharmacology, Toxicology and Pharmaceutics
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/32113
• Institution: Mahidol University

Background: The World Health Organization (WHO) recommends boosted protease inhibitor (bPI)-based HAART after failing non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment. We examined outcomes of this regimen in Asian HIV-infected children. Methods: Children from five Asian countries in the TREAT Asia Pediatric HIV Observational Database (TApHOD) with ≥24 weeks of NNRTI-based HAART followed by ≥24 weeks of bPI-based HAART were eligible. Primary outcomes were the proportions with virological suppression (HIV RNA<400 copies/ml) and immune recovery (CD4+T-cell percentage [CD4%]≥25% if age <5 years and CD4+T-cell count ≥500 cells/mm3if age ≥5 years) at 48 and 96 weeks. Results: Of 3,422 children, 153 were eligible; 52% were female. At switch, median age was 10 years, 26% were in WHO stage 4. Median weight-for-age z-score (WAZ) was -1.9 (n=121), CD4% was 12.5% (n=106), CD4+T-cell count was 237 cells/mm3(n=112), and HIV RNA was 4.6 log10copies/ml (n=61). The most common bPIwas lopinavir/ritonavir (83%). At 48 weeks, 61% (79/129) had immune recovery, 60% (26/43) had undetectable HIV RNA and 73% (58/79) had fasting triglycerides ≥130 mg/dl. By 96 weeks, 70% (57/82) achieved immune recovery, 65% (17/26) hadvirological suppression, and hypertriglyceridaemia occurred in 66% (33/50). Predictors for virological suppression at week 48 were longer duration of NNRTI-based HAART (P=0.006), younger age (P=0.007), higher WAZ (P=0.020) and HIV RNA at switch <10,000 copies/ml (P=0.049). Conclusions: In this regional cohort of Asian children on bPI-based second-line HAART, 60% of children tested had immune recovery by 1 year, and two-thirds had hyperlipidaemia, highlighting difficulties in optimizing secondline HAART with limited drug options. © 2013 International Medical Press.