Impact of low-level viraemia on virological failure among Asian children with perinatally acquired HIV on first-line combination antiretroviral treatment: a multicentre, retrospective cohort study

被引:11
作者
Sudjaritruk, Tavitiya [1 ,2 ]
Teeraananchai, Sirinya [3 ,4 ]
Kariminia, Azar [5 ]
Lapphra, Keswadee [6 ]
Kumarasamy, Nagalingeswaran [7 ]
Fong, Moy S. [8 ]
Hansudewechakul, Rawiwan [9 ]
Bunupuradah, Torsak [3 ]
Ly, Penh Sun [10 ]
Nallusamy, Revathy A. [11 ]
Sohn, Annette H. [12 ]
Sirisanthana, Virat [2 ]
机构
[1] Chiang Mai Univ, Fac Med, Dept Pediat, Chiang Mai, Thailand
[2] Chiang Mai Univ, Res Inst Hlth Sci, Chiang Mai, Thailand
[3] Thai Red Cross AIDS Res Ctr, HIV Netherlands Australia Thailand Res Collaborat, Bangkok, Thailand
[4] Kasetsart Univ, Fac Sci, Dept Stat, Bangkok, Thailand
[5] UNSW Australia, Kirby Inst, Sydney, NSW, Australia
[6] Mahidol Univ, Fac Med, Dept Pediat, Siriraj Hosp, Bangkok, Thailand
[7] VHS, Infect Dis Med Ctr, Chennai Antiviral Res & Treatment Clin Res Site, Chennai, Tamil Nadu, India
[8] Hosp Likas, Kota Kinabalu, Malaysia
[9] Chiangrai Prachanukroh Hosp, Chiang Rai, Thailand
[10] Natl Ctr HIV AIDS Dermatol & STDs, Phnom Penh, Cambodia
[11] Penang Hosp, George Town, Malaysia
[12] AmfAR Fdn Aids Res, TREAT Asia, Bangkok, Thailand
基金
美国国家卫生研究院;
关键词
viraemia; viral blip; viral rebound; paediatric; treatment failure; Asia; INFECTED PATIENTS; THERAPY; INTERMITTENT; RISK; ADHERENCE; EPISODES;
D O I
10.1002/jia2.25550
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction The clinical relevance of low-level viraemia (LLV) and virological outcomes among children living with HIV (CLHIV) remains controversial. This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first-line combination antiretroviral therapy (cART). Methods CLHIV aged <18 years, who were on first-line cART for >= 12 months, and had virological suppression (two consecutive plasma viral load [pVL] <50 copies/mL) were included. Those who started treatment with mono/dual antiretroviral therapy, had a history of treatment interruption >14 days, or received treatment and care at sites with a pVL lower limit of detection >50 copies/mL were excluded. LLV was defined as a pVL 50 to 1000 copies/mL, and VF as a single pVL >1000 copies/mL. Baseline was the time of the second pVL From January 2008 to September 2016, 508 CLHIV (55% female) were eligible for the study. At baseline, the median age was 9.6 (IQR: 7.0 to 12.3) years, cART duration was 1.4 (IQR: 1.3 to 1.8) years, 97% of CLHIV were on non-nucleoside reverse transcriptase inhibitor-based regimens, and the median CD4 was 25% (IQR: 20% to 30%). Over a median follow-up time of 6.0 (IQR: 3.1 to 8.9) years from baseline, 86 CLHIV (17%) had ever experienced LLV, of whom 32 (37%) had multiple LLV episodes. Female sex, living in Malaysia (compared to Cambodia), having family members other than biological parents/grandparents as a primary caregiver, and baseline CD4 < 25% increased risk of LLV. Overall, 115 children (23%) developed VF, corresponding to a rate of 4.0 (95%CI: 3.4 to 4.9) per 100 person-years of follow-up (PYFU). VF was greater among children who had ever experienced LLV compared with those who maintained virological suppression throughout the study period (8.9 vs. 3.3 per 100 PYFU;p < 0.001). In multivariable analyses, ever experiencing LLV was associated with increased risk of subsequent VF (adjusted hazard ratio: 3.01; 95%CI: 1.97 to 4.60). Conclusions LLV increased the risk of subsequent VF among Asian CLHIV who had previously been suppressed on first-line cART. Adherence interventions and additional targeted pVL monitoring may be warranted among children with LLV to facilitate early detection of VF.
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页数:11
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