The 10-Year Effectiveness of Combination Antiretroviral Treatment in Perinatally HIV-Infected Children Participating in Thailand's National Access Program
Free accessAnnouncementFirst published online April, 2016
The 10-Year Effectiveness of Combination Antiretroviral Treatment in Perinatally HIV-Infected Children Participating in Thailand's National Access Program
The National Access to Antiretroviral Program for People Living with HIV/AIDS was launched in Thailand in 2002. HIV-infected, antiretroviral-naive, severely immunosuppressed children were initiated on highly active combination antiretroviral treatment (cART). This study aimed to determine the long-term effectiveness of cART.
Methods
Data were extracted from medical records. Primary end points were mortality rate, proportion of children who remained on first-line cART regimen and children with plasma HIV RNA level (pVL) <50 copies/ml at week 520.
Results
From August 2002 to July 2003, 107 children were enrolled. The baseline median age was 7.6 years (IQR 5.7–10.0), the median CD4+ T-cell count was 60 cells/mm3 (IQR 21–272) and the median pVL was 5.37 log10 copies/ml (IQR 5.01–5.76). The mortality rate during and after the first year was 3.7 and 0.006 deaths/100 person-years, respectively. At week 520, 90 (84%) continued to be actively followed. Their median age was 17.8 years (IQR 15.8-19.8). 73 (81% as-treated) remained on the first-line regimen, while 18 (20%) had switched to a second-line cART regimen, at the median time of 272 weeks (IQR 256-363) after the first-line cART initiation. 69 (77%) had pVL<50 copies/ml and the median CD4+ T-cell count was 636 cells/mm3 (IQR 466-804). 83 (92%) and 64 (71%) had CD4+ T-cell counts ≥200 and >500 cells/mm3, respectively.
Conclusions
Long-term virological control, favourable immunological outcomes and healthy survival was achieved in severely immunosuppressed, perinatally HIV-infected children who started first-line NNRTI-based cART. Continuing surveillance for long-term complications is warranted.
References
1.
WHO, UNAIDS, UNICEF.Global HIV/AIDS response: epidemic update and health sector progress towards universal access, 2011 progress report. Geneva: World Health Organization; 2011. (Accessed 11 April 2016.) Available from http://apps.who.int/iris/bitstream/10665/44787/1/9789241502986_eng.pdf.
PuthanakitT., AurpibulL., OberdorferP.Hospitalization and mortality among HIV-infected children after receiving highly active antiretroviral therapy.Clin Infect Dis2007; 44: 599–604.
4.
LumbiganonP., KariminiaA., AurpibulL.TREAT Asia Pediatric HIV Observational Database (TApHOD). Survival of HIV-infected children: a cohort study from the Asia-Pacific region.J Acquir Immune Defic Syndr2011; 56: 365–371.
5.
KlineM.W., MatusaR.F., CopaciuL., CallesN.R., KlineN.E., SchwarzwaldH.L.Comprehensive pediatric human immunodeficiency virus care and treatment in Constanta, Romania: implementation of a program of highly active antiretroviral therapy in a resource-poor setting.Pediatr Infect Dis J2004; 23: 695–700.
6.
O'BrienD.P., SauvageotD., ZachariahR., HumbletP., Medecins Sans Frontieres. In resource-limited settings good early outcomes can be achieved in children using adult fixed-dose combination antiretroviral therapy.AIDS2006; 20: 1955–1960.
7.
VerweelG., van RossumA.M., HartwigN.G., WolfsT.F., ScherpbierH.J., de GrootR.Treatment with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected children is associated with a sustained effect on growth.Pediatrics2002; 109: E25.
8.
PalumboP.E., RaskinoC., FiscusS.Virologic and immunologic response to nucleoside reverse-transcriptase inhibitor therapy among human immunodeficiency virus-infected infants and children.J Infect Dis1999; 179: 576–583.
9.
SohnA.H., HazraR.The changing epidemiology of the global paediatric HIV epidemic: keeping track of perinatally HIV-infected adolescents.J Int AIDS Soc2013; 16: 18555.
10.
ChokephaibulkitK., KariminiaA., OberdorferP.TREAT Asia Pediatric HIV Observational Database. Characterizing HIV manifestations and treatment outcomes of perinatally infected adolescents in Asia.Pediatr Infect Dis J2014; 33: 291–294.
11.
CollinsI.J., JourdainG., HansudewechakulR.Long-term survival of HIV-infected children receiving antiretroviral therapy in Thailand: a 5-year observational cohort study.Clin Infect Dis2010; 51: 1449–1457.
12.
PuthanakitT., AurpibulL., OberdorferP.Sustained immunologic and virologic efficacy after four years of highly active antiretroviral therapy in human immunodeficiency virus infected children in Thailand.Pediatr Infect Dis J2007; 26: 953–956.
13.
ZhaoY., LiC., SunX.Mortality and treatment outcomes of China's National Pediatric antiretroviral therapy program.Clin Infect Dis2013; 56: 735–744.
14.
WanlessR.S., RuginăS., RuţăS.M.Nine-year follow-up of HIV-infected Romanian children and adolescents receiving lopinavir/ritonavir-containing highly active antiretroviral therapy.Germs2013; 3: 90–95.
15.
BracherL., ValeriusN.H., RosenfeldtV.Long-term effectiveness of highly active antiretroviral therapy (HAART) in perinatally HIV-infected children in Denmark.Scand J Infect Dis2007; 39: 799–804.
16.
CohenS., SmitC., van RossumA.M.Long-term response to combination antiretroviral therapy in HIV-infected children in the Netherlands registered from 1996 to 2012.AIDS2013; 27: 2567–2575.
17.
OworM., MwathaA., DonnellD.Long-term follow-up of children in the HIVNET 012 perinatal HIV prevention trial: five-year growth and survival.J Acquir Immune Defic Syndr2013; 64: 464–471.
18.
PatelK., HernánM.A., WilliamsP.L.Pediatric AIDS Clinical Trials Group 219/219C Study Team. Long-term effectiveness of highly active antiretroviral therapy on the survival of children and adolescents with HIV infection: a 10-year follow-up study.Clin Infect Dis2008; 46: 507–515.
19.
DollfusC., Le ChenadecJ., FayeA.Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French perinatal cohort (EPF/ANRS CO10).Clin Infect Dis2010; 51: 214–224.
