Determinants of highly active antiretroviral therapy duration in HIV-1-infected children and adolescents in Madrid, Spain, from 1996 to 2012

• Published in: PloS one 2014-05, Vol.9 (5), p.e96307-e96307
• Main Authors: Palladino, Claudia, Briz, Verónica, Bellón, José María, Climent, Francisco J, de Ory, Santiago J, Mellado, María José, Navarro, María Luisa, Ramos, José T, Taveira, Nuno, de José, María Isabel, Muñoz-Fernández, María Ángeles
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; Adolescent; Adolescents; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - methods; Antiviral agents; Bioengineering; Biology and Life Sciences; Biomedical materials; CD4 antigen; CD4 Lymphocyte Count; Child; Child, Preschool; Children; Disease prevention; Drug therapy; Female; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - drug effects; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infections; Lost to Follow-Up; Male; Medical laboratories; Medicine and health sciences; Moniz, Egas; Patient Compliance; Patients; Pediatrics; Pharmacy; Regression Analysis; Risk Factors; Spain; Surveys; Teenagers; Therapy; Viral Load - drug effects; Working groups
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0096307

To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents. Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain. Patients with a follow-up of ≥ 1 month spent on HAART, with available baseline CD4 count and HIV-viral load (VL) were included. Time spent on sequential HAART regimens was estimated and multivariable regression was used to identify predictors of time to first-line regimen discontinuation. 104 patients were followed for a median 8 years after starting HAART among 1996-2012; baseline %CD4 was 21.5 (12.3-34.0)and viral load was 5.1 (4.6-5.6) log10 copies/mL. Patients received a mean of 1.9 regimens. Median time on first-line HAART (n = 104) was 64.5 months; second HAART (n = 56) 69.8 months; and third HAART (n = 21) 66.5 months. Eleven (11%) patients were lost to follow-up while on first-line HAART and 54% discontinued (cumulative incidence of 16% and 38% by 1 and 3-year, respectively). The main predictor of first-line regimen discontinuation was suboptimal adherence to antiretrovirals (AHR: 2.60; 95% CI: 1.44-4.70). Adherence to therapy was the main determinant of the duration of the first-line HAART regimen in children. It is important to identify patients at high risk for non-adherence, such as very young children and adolescents, in provide special care and support to those patients.