ObjectivesVirological failure on first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based treatment regimens has become a problem in HIV-infected children on long-term antiretroviral therapy (ART). Protease inhibitor (PI)-based regimens are therefore often given to children failing NNRTI-based regimens. The aim of the study was to assess the 48-week effectiveness, safety and predictive factors for viral suppression of PI-based regimens in HIV-infected Thai children who had failed NNRTI-based regimens. MethodsThis study assessed 41 HIV-infected children who had failed first-line NNRTI-based regimens and were switched to PI-based regimens for at least 48 weeks. We assessed their CD4 cell counts, plasma HIV RNA levels, weight-for-age and height-for-age z-scores, and adverse events. ResultsThe children's median age was 9.5 years (range 1.5-15.8 years). At baseline, their median CD4 cell count was 276 cells/mL [interquartile range (IQR) 160-749 cells/mL], and their median plasma HIV RNA level was 4.5 log10 HIV-1 RNA copies/mL (IQR 3.9-4.8 log10 copies/mL). After 48 weeks of PI-based therapy, their CD4 cell counts increased to a median of 572 cells/mL (IQR 343-845 cells/mL) and in 73.2% plasma HIV RNA levels decreased to < 50 copies/mL. Their median weight-for-age and height-for-age z-scores were stable over the period of the study. Diarrhoea occurred in 29.3% of patients. Triglyceride levels were significantly higher at weeks 24 and 48 in comparison to baseline measurements. ConclusionsPI-based regimens are safe and effective for HIV-infected Thai children who have failed first-line NNRTI-based regimens. However, long-term follow-up is warranted in order to ascertain the feasibility and sustainability of these new regimens. Keywords: HIV-infected children, effectiveness, PI-based regimens Accepted 18 September 2012 IntroductionAccording to global estimates, in 2009 about 2.5 (1.7-3.4) million children under the age of 15 years were living with HIV infection [1], and at the end of 2009, about 356 400 of these children were receiving antiretroviral therapy (ART) [2]. The use of ART for the treatment of HIV infection in children has greatly changed the course of the disease, increasing survival rates and improving quality of life [3][4][5]. Children living with HIV are now surviving through adolescence into adult life, which creates new challenges in terms of adherence to treatment regimens, drug resistance and pill burdens. With expanding access to ART, many are experiencing treatment failures requiring second-line regimens [6][7][8] DOI: 10.1111/j.1468-1293.01061.x © 2012 British HIV Association HIV Medicine (2013 ORIGINAL RESEARCH 226In 2008, 10% of Asian and 3.3% of African HIV-infected children were on second-line ART [9]. The recommended second-line regimen for children who fail first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART is boosted protease inhibitors (PIs) with nucleoside reverse transcriptase inhibitors (NRTIs). World Health Organization (WHO) treatment guidelines...
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