Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Nov;65(5):651-659.
doi: 10.1016/j.jadohealth.2019.05.025. Epub 2019 Aug 5.

Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia

Adam W Bartlett  1 , Pagakrong Lumbiganon  2 , Nia Kurniati  3 , Tavitiya Sudjaritruk  4 , Thahira J Mohamed  5 , Rawiwan Hansudewechakul  6 , Penh S Ly  7 , Khanh H Truong  8 , Thanyawee Puthanakit  9 , Lam V Nguyen  10 , Kulkanya Chokephaibulkit  11 , Viet C Do  12 , Nagalingeswaran Kumarasamy  13 , Nik Khairulddin Nik Yusoff  14 , Moy S Fong  15 , Dewi K Watu  16 , Revathy Nallusamy  17 , Annette H Sohn  18 , Matthew G Law  19 ; TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific
Collaborators, Affiliations
Observational Study

Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia

Adam W Bartlett et al. J Adolesc Health. 2019 Nov.

Abstract

Purpose: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort.

Methods: Regional Asian data (2001-2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption.

Results: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes.

Conclusions: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.

Keywords: Adolescent; Antiretroviral therapy; HIV; Monotherapy; Treatment interruption.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Median CD4 trend (A) during monotherapy or treatment interruption and (B) with subsequent antiretroviral therapy after monotherapy or treatment interruption.
Figure 2.
Figure 2.
HIV viral load distribution with subsequent antiretroviral therapy following (A) monotherapy or (B) treatment interruption.
Figure 3.
Figure 3.
(A) WHO clinical stage III/IV event-free survival and (B) WHO advanced/severe immunologic event-free survivala during monotherapy or treatment interruption. aOnly patients who commenced monotherapy or a treatment interruption with a CD4 count >350 cell/μL included in analysis. WHO = World Health Organization.
Figure 4.
Figure 4.
Adjusted incidence rate ratio (with 95% confidence intervals) of monotherapy stratified by log HIV viral load. Adjusted for significant variables on multivariate regression analysis (current age, age at antiretroviral initiation, and number of prior combination antiretroviral regimens).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Agwu AL, Fairlie L. Antiretroviral treatment, management challenges and outcomes in perinatally HIV-infected adolescents. J Int AIDS Soc 2013;16: 18579. - PMC - PubMed
    1. Linder V, Goldswain C, Adler H, et al. Lamivudine monotherapy: Experience of medium-term outcomes in HIV-infected children unable to adhere to triple therapy. Pediatr Infect Dis J 2016;35:e199–205. - PubMed
    1. Bunupuradah T, Duong T, Compagnucci A, et al. Outcomes after reinitiating antiretroviral therapy in children randomized to planned treatment interruptions. AIDS 2013;27:579–89. - PubMed
    1. Wainberg MA. The impact of the M184V substitution on drug resistance and viral fitness. Expert Rev Anti Infect Ther 2004;2:147–51. - PubMed
    1. Wei X, Liang C, Gotte M, Wainberg MA. The M184V mutation in HIV-1 reverse transcriptase reduces the restoration of wild-type replication by attenuated viruses. AIDS 2002;16:2391–8. - PubMed

Publication types

Substances