Document Type
Journal Article
Study Type
cohortstudy
Publication Date
1-1-2016
Journal
Journal of the International AIDS Society
Volume
19
Issue
1
Inclusive Pages
20936
DOI
10.7448/IAS.19.1.20936
Abstract
INTRODUCTION: Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients.
METHODS: Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART ≥4 consecutive weeks. Data on TI, including 3TC monotherapy TI (MTI), were collected. Descriptive statistics and univariate testing were used to compare children with TI and MTI to children on continuous treatment (CT).
RESULTS: Thirty-eight (28%) out of 136 enrolled children (median age=12.9 years) experienced TI, with 14 (37%) of those placed on 3TC MTI. Significantly lower endpoint median CD4 counts (598 cells/mm(3) vs. 815 cells/mm(3); p=0.003) and CD4% (27.5% vs. 33%; p=0.006) were observed in the TI cohort as compared to the CT cohort. The median endpoint VL in the overall TI cohort was ~4 times higher than among the CT cohort (1427 copies/mL vs. 5581 copies/mL; p
CONCLUSIONS: In our study, we observed high frequency of the TI in HIV in paediatric HIV clinical practice. All TIs, including 3TC MTI, were associated with significantly lower endpoint median CD4 counts and higher median VLs, as compared to CT in paediatric patients. The high frequency of TI and associated poor outcomes suggest a need for a better strategy in managing the course of the paediatric and adolescent cART.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
APA Citation
Rakhmanina, N., Lam, K., Hern, J., Young, H. A., Walters, A., & Castel, A. D. (2016). Interruptions of antiretroviral therapy in children and adolescents with HIV infection in clinical practice: a retrospective cohort study in the USA.. Journal of the International AIDS Society, 19 (1). http://dx.doi.org/10.7448/IAS.19.1.20936
Peer Reviewed
1
Open Access
1
Included in
Biostatistics Commons, Epidemiology Commons, Public Health Education and Promotion Commons
Comments
Reproduced with permission of the International AIDS Society. Journal of the International AIDS Society