Long-term virologic suppression despite presence of resistance-associated mutations among perinatally HIV-infected youth

Tiffeny T. Smith, Alice J. Hsu, Nancy Hutton, Faith Womble, Allison L. Agwu

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is limited information on long-term consequences of continuing combination antiretroviral therapy (cART) consisting of <3 active drugs in treatment-experienced youth with perinatal HIV (PHIV). This study describes the clinical outcomes of PHIV youth who maintained virologic suppression (VS) for ≥1 year despite receiving cART with <3 active agents. Methods: A retrospective cohort study was conducted to quantify the duration of VS (viral load < 400 copies/mL), and using Cox proportional hazards regression, we identify factors associated with the primary outcome of virologic breakthrough (VB). Results: Thirty-seven patients were included. The median age, baseline CD4 count and HIV RNA viral load were 14 years, 477 cells/mm3 and 2920 copies/mL, respectively. All patients harbored reverse transcriptase, and 57% harbored protease mutations. The median duration of VS was 37 months (interquartile range: 22-66). Fifteen patients (41%) had VB. The median change in CD4 count during VS was +82 cells/mm3 at 12 months. The risk of VB was lower in those who gained ≥50 cells/mm3 by 12 months (unadjusted hazards ratio: 0.271; 95% confidence interval: 0.0825-0.893; P, 0.032); however, this was not significant in the adjusted model. Conclusions: VS was maintained for a median of 3 years without decline in CD4 count. Independent risk factors for VB were not identified; however, there was a trend toward higher risk of VB in those without CD4 gain of ≥50 cells/mm3 by 12 months. Suppressive cART containing <3 active agents could be an option in difficult to manage PHIV youth with close monitoring.

Original languageEnglish (US)
Pages (from-to)1365-1368
Number of pages4
JournalPediatric Infectious Disease Journal
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • HIV
  • antiretroviral
  • perinatal infection

ASJC Scopus subject areas

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

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