Characteristics of Treatment-experienced HIV-infected African Children and Adolescents Initiating Darunavir and/or Etravirine-based Antiretroviral Treatment

被引:5
作者
Corrigan, Bethany [1 ]
Mukui, Irene [2 ]
Mulenga, Lloyd [3 ,4 ]
Mthethwa, Nobuhle [5 ]
Letsie, Mosilinyane [6 ]
Bruno, Stephanie [1 ]
Rakhmanina, Natella [1 ,7 ,8 ]
机构
[1] EGPAF, Tech Assistance & Sustainabil, Washington, DC USA
[2] Minist Hlth, Natl AIDS & STI Control Program, Nairobi, Kenya
[3] Univ Teaching Hosp, Adult Infect Dis Ctr, Lusaka, Zambia
[4] Univ Zambia, Sch Med, Lusaka, Zambia
[5] Minist Hlth, Mbabane, Eswatini
[6] Minist Hlth, Dis Control, Maseru, Lesotho
[7] Childrens Natl Hlth Syst, Div Infect Dis, Washington, DC USA
[8] George Washington Univ, Sch Med & Hlth Sci, Dept Pediat, Washington, DC 20052 USA
关键词
DRUG-RESISTANCE MUTATIONS; VIROLOGICAL FAILURE; THERAPY; EFFICACY; ADULTS; ART;
D O I
10.1097/INF.0000000000001843
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Data are limited on the selection and sequencing of second-line and third-line pediatric antiretroviral treatment (ART) in resource-limited settings. This study aimed to evaluate characteristics of African pediatric patients initiated on darunavir (DRV) and/or etravirine (ETR) through a specific drug donation program. Methods: This was a cross-sectional study of baseline immunologic, virologic and demographic characteristics of children and adolescents initiating DRV-based and/or ETR-based ART. Descriptive statistics were used. Results: Study enrolled 48 patients (45.8% women; median age = 15 years [interquartile range 17.7-10.3]) at 9 clinical sites in Zambia, Swaziland, Kenya and Lesotho. The majority (87.5%; n = 42) had received 2 prior ART regimens; most (81.2%) had received lopinavir/ritonavir-based ART before switch. All patients had detectable HIV RNA (median = 56,653 copies/mL). Forty seven patients (98.9%) had HIV genotype results: 41 (87.2%) had 1 nucleos(t)ide reverse transcriptase inhibitor (NRTI)-resistance mutation (RM), predominantly M184V (76.6%; n = 36); 31 (65.9%) had 1 non-NRTI-RM, including 27 (57.4%) with 1 ETR-RM; 30 (63.8%) had 3 protease inhibitor RM, including 20 (42.6%) with 1 DRV-RM. For new ART regimens, DRV and raltegravir were most frequently prescribed (83.3%; n = 40 on DRV and raltegravir, each). Eighteen patients (37.5%) were initiated on the NRTI-sparing ART. Conclusions: In our study, a significant proportion of treatment-experienced African children and adolescents had one or more DRV-RM and ETR-RM. For the new regimen, more than a third of pediatric patients failing second-line ART were prescribed NRTI-sparing regimens. Better understanding of the current approaches to pediatric ART sequencing in resource-limited settings is needed.
引用
收藏
页码:669 / 672
页数:4
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