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. 2012 Dec;31(12):1279-83.
doi: 10.1097/INF.0b013e31826fd3e7.

Antiretroviral treatment strategies in highly treatment experienced perinatally HIV-infected youth

Frances L Wong  1 , Alice J Hsu, Paul A Pham, George K Siberry, Nancy Hutton, Allison L Agwu
Affiliations

Antiretroviral treatment strategies in highly treatment experienced perinatally HIV-infected youth

Frances L Wong et al. Pediatr Infect Dis J. 2012 Dec.

Abstract

Background: There is limited information on antiretroviral (ARV) regimens and outcomes in perinatally HIV (PHIV)-infected youth. Substantial drug resistance after long-term ARV use and nonadherence hinder efforts to design suppressive regimens for PHIV-infected youth. This study compares clinical outcomes by expected activity of the prescribed ARV regimens.

Methods: A retrospective cohort study of 13- to 24-year-old PHIV-infected youth on stable ARV regimens for ≥6 months was conducted at a pediatric HIV clinic. ARV regimens were retrospectively categorized as optimal or suboptimal based on accumulated genotypic resistance before study regimen initiation.

Results: Fifty-two patients with similar baseline characteristics met inclusion criteria (21 optimal and 31 suboptimal regimens). Patients receiving optimal regimens had significantly higher increases in CD4 than those given suboptimal regimens by week 48 of treatment (+62 versus +8 cells/mm, respectively; P = 0.04) and by the end of study period (+93 versus -1 cells/mm, respectively; P = 0.03). There were no significant differences between the groups in decline of viral load, frequency of opportunistic infections or hospitalizations or accumulation of resistance mutations. Overall, 60% of the optimal and 45% of the suboptimal groups had nonadherence during the study regimen (P = 0.3).

Conclusions: PHIV-infected youth receiving optimal regimens had greater CD4 improvements but no difference in virologic outcomes compared with those receiving suboptimal regimens. In a patient population with significant nonadherence, providers must weigh the immunologic benefits of initiating an optimal regimen versus the potential risks of further resistance accumulation limiting future treatment options.

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Figures

Figure 1
Figure 1. Description of study population selection
Note: ARV = antiretroviral
Figure 2A
Figure 2A. Comparison of changes in CD4
Median change in CD4 over the course of the antiretroviral regimen (optimal vs. suboptimal)
Figure 2B
Figure 2B. Comparison of changes in viral load (VL)
Median change in HIV-1 viral load (VL) during the course of the antiretroviral regimen (optimal vs. suboptimal) All calculated median changes at each time point are changes from baseline.
Figure 2C
Figure 2C. Comparison of proportion of patients achieving viral load (VL) < 400 copies/mL
Proportion of patients achieving HIV-1 viral load (VL) < 400 copies/mL during the course of the antiretroviral regimen (optimal vs. suboptimal)
See this image and copyright information in PMC

Comment in

References

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