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. 2021 Jul 1;87(3):993-1001.
doi: 10.1097/QAI.0000000000002678.

Outcomes After Second-Line Antiretroviral Therapy in Children Living With HIV in Latin America

Kayla Somerville  1 , Cathy A Jenkins  2 , James G Carlucci  3 , Anna K Person  4 , Daisy M Machado  5 , Marco T Luque  6 , Jorge A Pinto  7 , Vanessa Rouzier  8 , Ruth K Friedman  9 , Catherine C McGowan  4 , Bryan E Shepherd  2 , Peter F Rebeiro  2   4   10
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Outcomes After Second-Line Antiretroviral Therapy in Children Living With HIV in Latin America

Kayla Somerville et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Little is known about the long-term outcomes of children living with HIV in Latin America. Few studies have examined antiretroviral therapy (ART) regimen switches in the years after the introduction of ART in this population. This study aimed to assess clinical outcomes among children who started second-line ART in the Caribbean, Central and South America network for HIV epidemiology.

Methods: Children (<18 years old) with HIV who switched to second-line ART at sites within Caribbean, Central and South America network for HIV epidemiology were included. The cumulative incidence and relative hazards of virologic failure while on second-line ART, loss to follow-up, additional major ART regimen changes, and all-cause mortality were evaluated using competing risks methods and Cox models.

Results: A total of 672 children starting second-line ART were included. Three years after starting second-line ART, the cumulative incidence of death was 0.10 [95% confidence interval (CI) 0.08 to 0.13], loss to follow-up was 0.14 (95% CI: 0.11 to 0.17), and major regimen change was 0.19 (95% CI: 0.15 to 0.22). Of those changing regimens, 35% were due to failure and 11% due to toxicities/side effects. Among the 312 children with viral load data, the cumulative incidence of virologic failure at 3 years was 0.62 (95% CI: 0.56 to 0.68); time to virologic failure and regimen change were uncorrelated (rank correlation -0.001; 95% CI -0.18 to 0.17).

Conclusions: Poor outcomes after starting second-line ART in Latin America were common. The high incidence of virologic failure and its poor correlation with changing regimens was particularly worrisome. Additional efforts are needed to ensure children receive optimal ART regimens.

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Conflict of interest statement

P.F.R. has received an honorarium from Gilead. All authors are currently receiving a grant (U01AI069923) from NIH (NICHD, NCI, NIAID, NIMH, and OD); this work was also supported by separate grants from the NIH/NIAID (K01-AI131895, P.F.R.). The remaining authors have no conflicts of interest to disclose.

Figures

Figure 1A.
Figure 1A.
Cumulative incidence of loss to follow-up for children after starting second-line ART, by country and overall.
Figure 1B.
Figure 1B.
Cumulative incidence of all-cause mortality for children after starting second-line ART, by country and overall.
Figure 1C.
Figure 1C.
Cumulative incidence of a major regimen change after starting second-line ART, by country and overall.
Figure 1D.
Figure 1D.
Cumulative incidence of virologic failure for children after starting second-line ART, by country and overall.* *Viral load data were unavailable for individuals from Haiti for the duration of the study.
See this image and copyright information in PMC

References

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