Determinants of Highly Active Antiretroviral Therapy Duration in HIV-1-Infected Children and Adolescents in Madrid, Spain, from 1996 to 2012

Abstract

ObjectivesTo investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents.DesignMulticentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain.MethodsPatients 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.Results104 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).ConclusionsAdherence 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.

Pregnancy outcomes in perinatally HIV-infected young women in Madrid, Spain: 2000-2015

“…Additionally, the characteristics of PHIV women before pregnancy were requested and obtained from two observational Cohorts: the Madrid Cohort of HIV-infected children and the Spanish Cohort of HIV-infected children and adolescents (CoRISPE). [ 14 , 15 ]…”

Reasons and Risk Factors for the Initial Regimen Modification in Chinese Treatment-Naïve Patients with HIV Infection: A Retrospective Cohort Analysis

“…Toxicity of cART have been associated with demographic characteristics, drug-drug interactions, comorbidities, and genetic factors [ 9 – 13 ], and they has been reported with all antiretroviral drugs and are one of the most common reasons for modification of treatment [ 14 , 15 ]. The modification of the initial cART can do harm to the outcome of HIV infected patients [ 16 , 17 ], because subsequent regimens are often more complex and expensive, and at the same time, modification of regimen requires more clinical visits and laboratory tests [ 18 ]. So it is obvious that how to choose the fittest regimen for an individual with HIV infection is extraordinarily important.…”

Virologic Failure and its Determinant Factors among Children in First Line on Highly Active Anti Retroviral Therapy at Felegehiwot Referral Hospital, Bahir Dar, Northwest, Ethiopia: cross-sectional study

“…However, there are different factors that can affect the ability of HAART to suppress viral replication: viral resistance, and inadequate adherence to therapy, the limited access of paediatric regimens, conducting herbal faith healing and require long term therapy with unknown long term side effect, ambulatory/bedridden functional status at initiation and inadequate dosage guideline for specific HAART and age group, the challenges of paediatric ART adherence and the likelihood of HIV drug resistance development raise great public health concern about virologic failure in children [6][7][8][9][10][11][12][13].…”