Antiretroviral treatment strategies in highly treatment experienced perinatally HIV-infected youth

Frances L. Wong, Alice J. Hsu, Paul Pham, George K. Siberry, Nancy Hutton, Allison Lorna Agwu

Research output: Contribution to journalArticle

Abstract

BACKGROUND: There is limited information on antiretroviral (ARV) regimens and outcomes in perinatally HIV (PHIV)-infected youth. Substantial drug resistance after long-term ARV use and nonadherence hinder efforts to design suppressive regimens for PHIV-infected youth. This study compares clinical outcomes by expected activity of the prescribed ARV regimens. METHODS: A retrospective cohort study of 13- to 24-year-old PHIV-infected youth on stable ARV regimens for ≥6 months was conducted at a pediatric HIV clinic. ARV regimens were retrospectively categorized as optimal or suboptimal based on accumulated genotypic resistance before study regimen initiation. RESULTS: Fifty-two patients with similar baseline characteristics met inclusion criteria (21 optimal and 31 suboptimal regimens). Patients receiving optimal regimens had significantly higher increases in CD4 than those given suboptimal regimens by week 48 of treatment (+62 versus +8 cells/mm3, respectively; P = 0.04) and by the end of study period (+93 versus -1 cells/mm3, respectively; P = 0.03). There were no significant differences between the groups in decline of viral load, frequency of opportunistic infections or hospitalizations or accumulation of resistance mutations. Overall, 60% of the optimal and 45% of the suboptimal groups had nonadherence during the study regimen (P = 0.3). CONCLUSIONS: PHIV-infected youth receiving optimal regimens had greater CD4 improvements but no difference in virologic outcomes compared with those receiving suboptimal regimens. In a patient population with significant nonadherence, providers must weigh the immunologic benefits of initiating an optimal regimen versus the potential risks of further resistance accumulation limiting future treatment options.

Original languageEnglish (US)
Pages (from-to)1279-1283
Number of pages5
JournalPediatric Infectious Disease Journal
Volume31
Issue number12
DOIs
StatePublished - Dec 2012

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HIV
Therapeutics
Opportunistic Infections
Viral Load
Drug Resistance
Hospitalization
Cohort Studies
Retrospective Studies
Pediatrics
Population

Keywords

  • Antiretroviral
  • HIV
  • Perinatally HIV-infected youth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Antiretroviral treatment strategies in highly treatment experienced perinatally HIV-infected youth. / Wong, Frances L.; Hsu, Alice J.; Pham, Paul; Siberry, George K.; Hutton, Nancy; Agwu, Allison Lorna.

In: Pediatric Infectious Disease Journal, Vol. 31, No. 12, 12.2012, p. 1279-1283.

Research output: Contribution to journalArticle

Wong, Frances L. ; Hsu, Alice J. ; Pham, Paul ; Siberry, George K. ; Hutton, Nancy ; Agwu, Allison Lorna. / Antiretroviral treatment strategies in highly treatment experienced perinatally HIV-infected youth. In: Pediatric Infectious Disease Journal. 2012 ; Vol. 31, No. 12. pp. 1279-1283.
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