The University of Southampton
University of Southampton Institutional Repository

Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland

Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland
Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland
Objective: To assess factors at the start of antiretroviral therapy (ART) associated with long-term virological response in children.

Design: Multicentre national cohort.

Methods: Factors associated with viral load below 400 copies/ml by 12 months and virologic failure among children starting 3/4-drug ART in the UK/Irish Collaborative HIV Paediatric Study were assessed using Poisson models.

Results: Nine hundred and ninety-seven children started ART at a median age of 7.7 years (inter-quartile range 2.9-11.7), 251 (25%) below 3 years: 411 (41%) with efavirenz and two nucleoside reverse transcriptase inhibitors (EFV + 2NRTIs), 264 (26%) with nevirapine and two NRTIs (NVP + 2NRTIs), 119 (12%; 106 NVP, 13 EFV) with non-nucleoside reverse transcriptase inhibitor and three NRTIs (NNRTI + 3NRTIs), and 203 (20%) with boosted protease inhibitor-based regimens. Median follow-up after ART initiation was 5.7 (3.0-8.8) years. Viral load was less than 400 copies/ml by 12 months in 92% [95% confidence interval (CI) 91-94%] of the children. Time to suppression was similar across regimens (P = 0.10), but faster over calendar time, with older age and lower baseline viral load. Three hundred and thirty-nine (34%) children experienced virological failure. Although progression to failure varied by regimen (P < 0.001) and was fastest for NVP + 2NRTIs regimens, risk after 2 years on therapy was similar for EFV + 2NRTIs and NVP + 2NRTIs, and lowest for NNRTI + 3NRTIs regimens (P-interaction = 0.03). Older age, earlier calendar periods and maternal ART exposure were associated with increased failure risk. Early treatment discontinuation for toxicity occurred more frequently for NVP-based regimens, but 5-year cumulative incidence was similar: 6.1% (95% CI 3.9-8.9%) NVP, 8.3% (95% CI 5.6-11.6) EFV, and 9.8% (95% CI 5.7-15.3%) protease inhibitor-based regimens (P = 0.48).
antiretroviral therapy, children, hiv, uk/Ireland, virological outcome
2395-2405
Duong, Trinh
17ec4fed-36a0-49b2-bc51-17158ca8b22b
Judd, Ali
1d37f223-9f32-47e8-b10c-00f7bdb86b73
Collins, Intira Jeannie
d60851b4-fd27-436e-915e-c0e43cbba39c
Doerholt, Katja
4f8fdb18-68d4-47b0-8d22-d46129018626
Lyall, Hermione
9c1a03ee-edfb-419d-bd39-04261a500d90
Foster, Caroline
5c87be00-dda9-47fb-9d42-18707b22b4bd
Butler, Karina
08b79816-a436-4e16-b53e-fd9b3361a21c
Tookey, pat
7093ae82-efaf-434f-bc4c-4ddd73aeec00
Shingadia, Delane
39be5e42-ee95-46df-8a0f-23505be4266e
Menson, Esse
316577d2-4c28-43e8-8dba-9f1da95fb41f
Dunn, David T.
eac4df11-b985-4288-82b5-1272e538066b
Gibb, Di M.
d95a46a1-63fe-45a3-a4da-211c893018b8
Faust, S.N.
f97df780-9f9b-418e-b349-7adf63e150c1
Duong, Trinh
17ec4fed-36a0-49b2-bc51-17158ca8b22b
Judd, Ali
1d37f223-9f32-47e8-b10c-00f7bdb86b73
Collins, Intira Jeannie
d60851b4-fd27-436e-915e-c0e43cbba39c
Doerholt, Katja
4f8fdb18-68d4-47b0-8d22-d46129018626
Lyall, Hermione
9c1a03ee-edfb-419d-bd39-04261a500d90
Foster, Caroline
5c87be00-dda9-47fb-9d42-18707b22b4bd
Butler, Karina
08b79816-a436-4e16-b53e-fd9b3361a21c
Tookey, pat
7093ae82-efaf-434f-bc4c-4ddd73aeec00
Shingadia, Delane
39be5e42-ee95-46df-8a0f-23505be4266e
Menson, Esse
316577d2-4c28-43e8-8dba-9f1da95fb41f
Dunn, David T.
eac4df11-b985-4288-82b5-1272e538066b
Gibb, Di M.
d95a46a1-63fe-45a3-a4da-211c893018b8
Faust, S.N.
f97df780-9f9b-418e-b349-7adf63e150c1

Duong, Trinh, Judd, Ali, Collins, Intira Jeannie, Doerholt, Katja, Lyall, Hermione, Foster, Caroline, Butler, Karina, Tookey, pat, Shingadia, Delane, Menson, Esse, Dunn, David T., Gibb, Di M. and Faust, S.N. (2014) Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland. AIDS, 28 (16), 2395-2405. (doi:10.1097/QAD.0000000000000438).

Record type: Article

Abstract

Objective: To assess factors at the start of antiretroviral therapy (ART) associated with long-term virological response in children.

Design: Multicentre national cohort.

Methods: Factors associated with viral load below 400 copies/ml by 12 months and virologic failure among children starting 3/4-drug ART in the UK/Irish Collaborative HIV Paediatric Study were assessed using Poisson models.

Results: Nine hundred and ninety-seven children started ART at a median age of 7.7 years (inter-quartile range 2.9-11.7), 251 (25%) below 3 years: 411 (41%) with efavirenz and two nucleoside reverse transcriptase inhibitors (EFV + 2NRTIs), 264 (26%) with nevirapine and two NRTIs (NVP + 2NRTIs), 119 (12%; 106 NVP, 13 EFV) with non-nucleoside reverse transcriptase inhibitor and three NRTIs (NNRTI + 3NRTIs), and 203 (20%) with boosted protease inhibitor-based regimens. Median follow-up after ART initiation was 5.7 (3.0-8.8) years. Viral load was less than 400 copies/ml by 12 months in 92% [95% confidence interval (CI) 91-94%] of the children. Time to suppression was similar across regimens (P = 0.10), but faster over calendar time, with older age and lower baseline viral load. Three hundred and thirty-nine (34%) children experienced virological failure. Although progression to failure varied by regimen (P < 0.001) and was fastest for NVP + 2NRTIs regimens, risk after 2 years on therapy was similar for EFV + 2NRTIs and NVP + 2NRTIs, and lowest for NNRTI + 3NRTIs regimens (P-interaction = 0.03). Older age, earlier calendar periods and maternal ART exposure were associated with increased failure risk. Early treatment discontinuation for toxicity occurred more frequently for NVP-based regimens, but 5-year cumulative incidence was similar: 6.1% (95% CI 3.9-8.9%) NVP, 8.3% (95% CI 5.6-11.6) EFV, and 9.8% (95% CI 5.7-15.3%) protease inhibitor-based regimens (P = 0.48).

Full text not available from this repository.

More information

Published date: 23 October 2014
Keywords: antiretroviral therapy, children, hiv, uk/Ireland, virological outcome
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 375902
URI: http://eprints.soton.ac.uk/id/eprint/375902
PURE UUID: be3e0caf-2515-4df3-b00c-2b1d029f9495
ORCID for S.N. Faust: ORCID iD orcid.org/0000-0003-3410-7642

Catalogue record

Date deposited: 20 Apr 2015 12:11
Last modified: 18 Feb 2021 17:07

Export record

Altmetrics

Contributors

Author: Trinh Duong
Author: Ali Judd
Author: Intira Jeannie Collins
Author: Katja Doerholt
Author: Hermione Lyall
Author: Caroline Foster
Author: Karina Butler
Author: pat Tookey
Author: Delane Shingadia
Author: Esse Menson
Author: David T. Dunn
Author: Di M. Gibb
Author: S.N. Faust ORCID iD

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×