Outcomes of second‐line antiretroviral therapy among children living with HIV: a global cohort analysis

• Published in: Journal of the International AIDS Society 2020-04, Vol.23 (4), p.e25477-n/a
• Main Authors: Patel, Kunjal, Smith, Colette, Collins, Intira Jeannie, Goodall, Ruth, Abrams, Elaine J, Sohn, Annette H, Mohamed, Thahira J, Van Dyke, Russell B, Rojo, Pablo, Wools‐Kaloustian, Kara, Pinto, Jorge, Edmonds, Andrew, Marete, Irene, Paul, Mary, Nuwaqaba‐Biribonwoha, Harriet, Leroy, Valériane, Davies, Mary‐Ann, Vreeman, Rachel, Maxwell, Nicky, Timmerman, Venessa, Duff, Charlotte, Mofenson, Lynne, Bekker, Linda‐Gail, Vicari, Marissa, Essajee, Shaffiq, Penazzato, Martina, Slogrove, Amy, Williams, Paige, Crichton, Siobhan, Seage, George, Thahane, Lineo, Kazembe, Peter N, Lukhele, Bhekumusa, Mwita, Lumumba, Kekitiinwa‐Rukyalekere, Adeodata, Wanless, Sebastian, Matshaba, Mogomotsi S, Goetghebuer, Tessa, Thorne, Claire, Warszawski, Josiane, Galli, Luisa, Geelen, Sybil, Gibb, Diana M, Giaquinto, Carlo, Marczynska, Magdalena, Marques, Laura, Prata, Filipa, Ene, Luminita, Okhonskaia, Liubov, Noguera‐Julian, Antoni, Naver, Lars, Rudin, Christoph, Jourdain, Gonzague, Judd, Ali, Volokha, Alla, Rouzier, Vanessa, Succi, Regina, Kariminia, Azar, Yotebieng, Marcel, Lelo, Patricia, Lyamuya, Rita, Oyaro, Patrick, Boulle, Andrew, Malisita, Kennedy, Fatti, Geoffrey, Haas, Andreas D, Desmonde, Sophie, Dicko, Fatoumata, Abzug, Mark J, Purswani, Murli, Van Dyke, Russell, Chadwick, Ellen, Abrams, Elaine, Teasdale, Chloe, Nuwagaba, Harriet
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Analysis; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; antiretroviral therapy; CD4 Lymphocyte Count; Child; Child health; Child, Preschool; children; Cohort analysis; Cohort Studies; Collaboration; Drug therapy; Efavirenz; Female; France; Global Health; Health aspects; Highly active antiretroviral therapy; HIV; HIV infection in children; HIV Infections - drug therapy; HIV patients; Human immunodeficiency virus; Humans; Incidence; Latin America; Life Sciences; Male; Medicin och hälsovetenskap; Mortality; North America; outcomes; Patient outcomes; Pediatric research; Pediatrics; perinatal HIV; Protease inhibitors; Proteases; second‐line; South Africa; Statistics; Studies; Sub-Saharan Africa; Thailand; Treatment Failure; Treatment Outcome; United Kingdom
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25477

Introduction Limited data describe outcomes on second‐line antiretroviral therapy (ART) among children globally. Our objective was to contribute data on outcomes among children living with HIV after initiation of second‐line ART in the context of routine care within a large global cohort collaboration. Methods Patient‐level data from 1993 through 2015 from 11 paediatric HIV cohorts were pooled. Characteristics at switch and through two years of follow‐up were summarized for children who switched to second‐line ART after starting a standard first‐line regimen in North America, Latin America, Europe, Asia, Southern Africa (South Africa & Botswana) and the rest of sub‐Saharan Africa (SSA). Cumulative incidences of mortality and loss to follow‐up (LTFU) were estimated using a competing risks framework. Results Of the 85,389 children on first‐line ART, 3,555 (4%) switched to second‐line after a median of 2.8 years on ART (IQR: 1.6, 4.7); 69% were from Southern Africa or SSA and 86% of second‐line regimens were protease inhibitor‐based. At switch, median age was 8.4 years and 50% had a prior AIDS diagnosis. Median follow‐up after switch to second‐line ranged from 1.8 years in SSA to 5.3 years in North America. Median CD4 counts at switch to second‐line ranged from 235 cells/mm3 in SSA to 828 cells/mm3 in North America. Improvements in CD4 counts were observed over two years of follow‐up, particularly in regions with lower CD4 counts at second‐line switch. Improvements in weight‐for‐age z‐scores were not observed during follow‐up. Cumulative incidence of LTFU at two years was