European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord2025-01-072025-01-072018https://hdl.handle.net/10668/24946Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Children aged Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.enHIVantiretroviral therapychildrensecond-lineswitchAge FactorsAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveChildChild, PreschoolCohort StudiesDrug Resistance, ViralDrug SubstitutionEuropeFemaleHIV InfectionsHumansInfantMaleReverse Transcriptase InhibitorsThailandTime FactorsTreatment FailureViral Loadresearch article29029056open access10.1093/cid/cix8541537-6591PMC5796645https://academic.oup.com/cid/article-pdf/66/4/594/24020876/cix854.pdfhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5796645/pdf