Abstract
BackgroundLimited data exist for the efficacy of second-line antiretroviral therapy among children in resource limited settings. We assessed the virologic response to protease inhibitor-based ART after failing first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens.MethodsA retrospective chart review was conducted at 8 Thai sites of children who switched to PI –based regimens due to failure of NNRTI –based regimens. Primary endpoints were HIV RNA < 400 copies/ml and CD4 change over 48 weeks.ResultsData from 241 children with median baseline values before starting PI-based regimens of 9.1 years for age, 10% for CD4%, and 4.8 log10 copies/ml for HIV RNA were included; 104 (41%) received a single ritonavir-boosted PI (sbPI) with 2 NRTIs and 137 (59%) received double-boosted PI (dbPI) with/without NRTIs based on physician discretion. SbPI children had higher baseline CD4 (17% vs. 6%, p < 0.001), lower HIV RNA (4.5 vs. 4.9 log10 copies/ml, p < 0.001), and less frequent high grade multi-NRTI resistance (12.4% vs 60.5%, p < 0.001) than the dbPI children. At week 48, 81% had HIV RNA < 400 copies/ml (sbPI 83.1% vs. dbPI 79.8%, p = 0.61) with a median CD4 rise of 9% (+7%vs. + 10%, p < 0.005). However, only 63% had HIV RNA < 50 copies/ml, with better viral suppression seen in sbPI (76.6% vs. 51.4%, p 0.002).ConclusionSecond-line PI therapy was effective for children failing first line NNRTI in a resource-limited setting. DbPI were used in patients with extensive drug resistance due to limited treatment options. Better access to antiretroviral drugs is needed.
Highlights
The most commonly used first-line antiretroviral therapy (ART) in HIV-infected children in resource-limited settings (RLS) is a non nucleoside reverse transcriptase inhibitor (NNRTI)-based treatment[1,2]
In RLS without routine virologic monitoring, the diagnosis of treatment failure is usually late, of which brings about concerns for multi-nucleoside reverse transcriptase inhibitors (NRTIs) resistance [11]
There were 104 children who switched to single-boosted PI and 137 children who switched to double-boosted PI (137 children) at 8 HIV pediatric clinics
Summary
The most commonly used first-line antiretroviral therapy (ART) in HIV-infected children in resource-limited settings (RLS) is a non nucleoside reverse transcriptase inhibitor (NNRTI)-based treatment[1,2]. Reported incidence rate of multi-NRTI drug resistance from cohort with routine viral load monitoring is only 8% [12] compared to 36% seen in settings in which treatment failure was detected by clinical or immunologic criteria [13]. In such cases in RLS, the only effective anti-retroviral (ARV) drug option available for secondline therapy is boosted PI with limited choices for effective NRTIs. Often times, double-boosted PI regimens are used to provide 2 active agents in the regimen. We assessed the virologic response to protease inhibitor-based ART after failing first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
