Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

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Abstract

Background:

Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line.

Methods:

Children initiating their first ART regimen between 2-14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: First-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program [LTP]). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event.

Results:

In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children <5 years was 13.2% and CD4 count for those >5 years was 258 cells/µl. Almost all (94.4%) initiated a non-nucleoside reverse transcriptase inhibitor (NNRTI); 5.3% a protease inhibitor (PI), and 0.3% a triple nucleoside (NRTI)–based regimen. At one year, 7.7% had failed and 14.4% had experienced attrition; by five years, the cumulative incidence was 25.9% and 29.4%, respectively. At one year after ART failure, 13.7% had transitioned to second-line and 11.2% had experience attrition; by five years, the cumulative incidence was 31.6% and 25.9%, respectively.

Conclusions:

High rates of first-line failure and attrition were identified in children within five years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within five years.

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