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
. 2021 Oct 5;73(7):e1919-e1926.
doi: 10.1093/cid/ciaa872.

Identification, Management, and Outcomes of Combination Antiretroviral Treatment Failure in Adolescents With Perinatal Human Immunodeficiency Virus Infection in Asia

Adam W Bartlett  1 , Tavitiya Sudjaritruk  2 , Thahira J Mohamed  3 , Suvaporn Anugulruengkit  4   5 , Nagalingeswaran Kumarasamy  6 , Wanatpreeya Phongsamart  7 , Penh Sun Ly  8 , Khanh Huu Truong  9 , Lam Van Nguyen  10 , Viet Chau Do  11 , Pradthana Ounchanum  12 , Thanyawee Puthanakit  4   5 , Kulkanya Chokephaibulkit  7 , Pagakrong Lumbiganon  13 , Nia Kurniati  14 , Nik Khairulddin Nik Yusoff  15 , Dewi Kumara Wati  16 , Annette H Sohn  17 , Azar Kariminia  1
Affiliations

Identification, Management, and Outcomes of Combination Antiretroviral Treatment Failure in Adolescents With Perinatal Human Immunodeficiency Virus Infection in Asia

Adam W Bartlett et al. Clin Infect Dis. .

Abstract

Background: Combination antiretroviral therapy (cART) failure is a major threat to human immunodeficiency virus (HIV) programs, with implications for individual- and population-level outcomes. Adolescents with perinatally acquired HIV infection (PHIVA) should be a focus for treatment failure given their poorer outcomes compared to children and adults.

Methods: Data (2014-2018) from a regional cohort of Asian PHIVA who received at least 6 months of continuous cART were analyzed. Treatment failure was defined according to World Health Organization criteria. Descriptive analyses were used to report treatment failure and subsequent management and evaluate postfailure CD4 count and viral load trends. Kaplan-Meier survival analyses were used to compare the cumulative incidence of death and loss to follow-up (LTFU) by treatment failure status.

Results: A total 3196 PHIVA were included in the analysis with a median follow-up period of 3.0 years, of whom 230 (7.2%) had experienced 292 treatment failure events (161 virologic, 128 immunologic, 11 clinical) at a rate of 3.78 per 100 person-years. Of the 292 treatment failure events, 31 (10.6%) had a subsequent cART switch within 6 months, which resulted in better immunologic and virologic outcomes compared to those who did not switch cART. The 5-year cumulative incidence of death and LTFU following treatment failure was 18.5% compared to 10.1% without treatment failure.

Conclusions: Improved implementation of virologic monitoring is required to realize the benefits of virologic determination of cART failure. There is a need to address issues related to accessibility to subsequent cART regimens, poor adherence limiting scope to switch regimens, and the role of antiretroviral resistance testing.

Keywords: HIV; adolescent; antiretroviral therapy; treatment failure.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Trends in median CD4 cell count (with 95% confidence intervals) following any treatment failure for those who switched combination antiretroviral therapy (cART) and those who did not.
Figure 2.
Figure 2.
Trends in median CD4 count (with 95% confidence intervals) following immunologic treatment failure (A) and virologic treatment failure (B) for those who switched combination antiretroviral therapy (cART) and those who did not.
Figure 3.
Figure 3.
Trends in human immunodeficiency virus (HIV) viral load after any treatment failure for adolescents with perinatally acquired HIV infection who switched combination antiretroviral therapy (cART) (A) and those who did not switch cART (B).
Figure 4.
Figure 4.
Cumulative incidence of death and loss to follow-up following treatment failure and for those who did not experience treatment failure.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization. 2015. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Available at: https://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/. Accessed 19 August 2019.
    1. Joint United Nations Programme on HIV/AIDS. 2014. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Available at: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf. Accessed 19 August 2019. - PubMed
    1. Boerma RS, Bunupuradah T, Dow D, et al. , Paediatric Second-line Study Group . Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure. J Int AIDS Soc 2017; 20:21930. - PMC - PubMed
    1. Mark D, Armstrong A, Andrade C, et al. . HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries. J Int AIDS Soc 2017; 20:25–33. - PMC - PubMed
    1. Enane LA, Vreeman RC, Foster C. Retention and adherence: global challenges for the long-term care of adolescents and young adults living with HIV. Curr Opin HIV AIDS 2018; 13:212–9. - PubMed

Publication types

Substances