%0 Journal Article
%A Judd, A
%A Lodwick, R
%A Noguera-Julian, A
%A Gibb, D M
%A Butler, K
%A Costagliola, D
%A Sabin, C
%A van Sighem, A
%A Ledergerber, B
%A Torti, C
%A Mocroft, A
%A Podzamczer, D
%A Dorrucci, M
%A De Wit, S
%A Obel, N
%A Dabis, F
%A Cozzi-Lepri, A
%A García, F
%A Brockmeyer, N H
%A Warszawski, J
%A Gonzalez-Tome, M I
%A Mussini, C
%A Touloumi, G
%A Zangerle, R
%A Ghosn, J
%A Castagna, A
%A Fätkenheuer, G
%A Stephan, C
%A Meyer, L
%A Campbell, M A
%A Chene, G
%A Phillips, A
%T Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe.
%D 2017
%@ 1464-2662
%U http://hdl.handle.net/10668/2688
%X OBJECTIVES:The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection.METHODS:We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI.RESULTS:The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4.CONCLUSIONS:The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.
%K Europe
%K Perinatal HIV infection
%K Virological failure
%K Young people
%K Adolescente
%K Adulto
%K Fármacos anti-VIH
%K Niño
%K Enfermedades transmisibles
%K Intervalos de confianza
%K Europa
%K Infecciones por VIH
%K VIH-1
%K Recién nacido
%K Heterosexualidad
%K Inhibidores de proteasas
%K ADN polimerasa dirigida por ADN
%K Inhibidores de la transcriptasa inversa
%K Factores de riesgo
%K Carga viral
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