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-...
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| Format: | Article |
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Lippincott, Williams & Wilkins
2014
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| Online Access: | https://eprints.nottingham.ac.uk/31690/ |
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| author | 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. Smyth, Alan R. |
| author_facet | 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. Smyth, Alan R. |
| author_sort | Duong, Trinh |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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 (EFVþ2NRTIs), 264 (26%) with nevirapine and two NRTIs (NVPþ2NRTIs), 119 (12%; 106 NVP, 13 EFV) with non-nucleoside reverse transcriptase inhibitor and three NRTIs (NNRTIþ3NRTIs), 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 (P¼0.10), but faster over calendar time, with older age and lower baseline viral load. Three hundred and thirtynine (34%) children experienced virological failure. Although progression to failure varied by regimen (P<0.001) and was fastest for NVPþ2NRTIs regimens, risk after 2 years on therapy was similar for EFVþ2NRTIs and NVPþ2NRTIs, and lowest for NNRTIþ3NRTIs regimens (P-interaction¼0.03). 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 (P¼0.48).
Conclusion: Viral load suppression by 12 months was high with all regimens. NVPþ3NRTIs regimens were particularly efficacious in the longer term and may be a good alternative to protease inhibitor-based ART in young children. |
| first_indexed | 2025-11-14T19:13:16Z |
| format | Article |
| id | nottingham-31690 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:13:16Z |
| publishDate | 2014 |
| publisher | Lippincott, Williams & Wilkins |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-316902024-08-15T15:16:13Z https://eprints.nottingham.ac.uk/31690/ Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland 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. Smyth, Alan R. 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 (EFVþ2NRTIs), 264 (26%) with nevirapine and two NRTIs (NVPþ2NRTIs), 119 (12%; 106 NVP, 13 EFV) with non-nucleoside reverse transcriptase inhibitor and three NRTIs (NNRTIþ3NRTIs), 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 (P¼0.10), but faster over calendar time, with older age and lower baseline viral load. Three hundred and thirtynine (34%) children experienced virological failure. Although progression to failure varied by regimen (P<0.001) and was fastest for NVPþ2NRTIs regimens, risk after 2 years on therapy was similar for EFVþ2NRTIs and NVPþ2NRTIs, and lowest for NNRTIþ3NRTIs regimens (P-interaction¼0.03). 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 (P¼0.48). Conclusion: Viral load suppression by 12 months was high with all regimens. NVPþ3NRTIs regimens were particularly efficacious in the longer term and may be a good alternative to protease inhibitor-based ART in young children. Lippincott, Williams & Wilkins 2014-10-23 Article PeerReviewed 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 Smyth, Alan R. (2014) Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland. AIDS, 28 (16). pp. 2395-2405. ISSN 1473-5571 antiretroviral therapy children HIV UK/Ireland virological outcome http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2014&issue=10230&article=00008&type=abstract doi:10.1097/QAD.0000000000000438 doi:10.1097/QAD.0000000000000438 |
| spellingShingle | antiretroviral therapy children HIV UK/Ireland virological outcome 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. Smyth, Alan R. Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland |
| title | Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland |
| title_full | Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland |
| title_fullStr | Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland |
| title_full_unstemmed | Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland |
| title_short | Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland |
| title_sort | long-term virological outcome in children on antiretroviral therapy in the uk and ireland |
| topic | antiretroviral therapy children HIV UK/Ireland virological outcome |
| url | https://eprints.nottingham.ac.uk/31690/ https://eprints.nottingham.ac.uk/31690/ https://eprints.nottingham.ac.uk/31690/ |