Judd, A., Lodwick, R., Noguera-Julian, A., Gibb, D. M., Butler, K., Costagliola, D., Sabin, C., van Sighem, A., Ledergerber, B., Torti, C., Mocroft, A., Podzamczer, D., Dorrucci, M., De Wit, S., Obel, N., Dabis, F., Cozzi-Lepri, A., Garcia, F., Brockmeyer, N. H., Warszawski, J., Gonzalez-Tome, M. I., Mussini, C., Touloumi, G., Zangerle, R., Ghosn, J., Castagna, A., Faetkenheuer, G., Stephan, C., Meyer, L., Campbell, M. A., Chene, G. and Phillips, A. (2017). Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe. HIV Med., 18 (3). S. 171 - 181. HOBOKEN: WILEY-BLACKWELL. ISSN 1468-1293

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Abstract

Objectives The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. Methods We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite >= 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. Results The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4. Conclusions The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Judd, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lodwick, R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Noguera-Julian, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gibb, D. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Butler, K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Costagliola, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sabin, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Sighem, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ledergerber, B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Torti, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mocroft, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Podzamczer, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dorrucci, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
De Wit, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Obel, N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dabis, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cozzi-Lepri, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Garcia, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brockmeyer, N. H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Warszawski, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gonzalez-Tome, M. I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mussini, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Touloumi, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zangerle, R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ghosn, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Castagna, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Faetkenheuer, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stephan, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meyer, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Campbell, M. A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chene, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Phillips, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-238993
DOI: 10.1111/hiv.12411
Journal or Publication Title: HIV Med.
Volume: 18
Number: 3
Page Range: S. 171 - 181
Date: 2017
Publisher: WILEY-BLACKWELL
Place of Publication: HOBOKEN
ISSN: 1468-1293
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ANTIRETROVIRAL THERAPY; ACQUIRED HIV; ADOLESCENTS; CARE; TRANSITION; REGIMENS; OUTCOMESMultiple languages
Infectious DiseasesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/23899

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