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Title: Second-line protease inhibitor-based HAART after failing non-nucleoside reverse transcriptase inhibitorbased regimens in Asian HIV-infected children
Authors: Torsak Bunupuradah
Thanyawee Puthanakit
Paul Fahey
Azar Kariminia
Nik K.N. Yusoff
Truong H. Khanh
Annette H. Sohn
Kulkanya Chokephaibulkit
Pagakrong Lumbiganon
Rawiwan Hansudewechakul
Kamarul Razali
Nia Kurniati
Bui V. Huy
Tavitiya Sudjaritruk
Nagalingeswaran Kumarasamy
Siew M. Fong
Vonthanak Saphonn
Jintanat Ananworanich
The HIV Netherlands Australia Thailand Research Collaboration
Chulalongkorn University
University of New South Wales (UNSW) Australia
Hospital Raja Perempuan Zainab II
Children Hospital Number 1
Foundation for AIDS Research
Mahidol University
Khon Kaen University
Chiangrai Prachanukroh Hospital
Kuala Lumpur Hospital
University of Indonesia, RSUPN Dr. Cipto Mangunkusumo
National Hospital of Pediatrics Hanoi
Chiang Mai University
YR Gaitonde Centre for AIDS Research and Education
Hospital Likas
National Pediatric Hospital
Keywords: Medicine;Pharmacology, Toxicology and Pharmaceutics
Issue Date: 16-Oct-2013
Citation: Antiviral Therapy. Vol.18, No.4 (2013), 591-598
Abstract: Background: The World Health Organization (WHO) recommends boosted protease inhibitor (bPI)-based HAART after failing non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment. We examined outcomes of this regimen in Asian HIV-infected children. Methods: Children from five Asian countries in the TREAT Asia Pediatric HIV Observational Database (TApHOD) with ≥24 weeks of NNRTI-based HAART followed by ≥24 weeks of bPI-based HAART were eligible. Primary outcomes were the proportions with virological suppression (HIV RNA<400 copies/ml) and immune recovery (CD4+T-cell percentage [CD4%]≥25% if age <5 years and CD4+T-cell count ≥500 cells/mm3if age ≥5 years) at 48 and 96 weeks. Results: Of 3,422 children, 153 were eligible; 52% were female. At switch, median age was 10 years, 26% were in WHO stage 4. Median weight-for-age z-score (WAZ) was -1.9 (n=121), CD4% was 12.5% (n=106), CD4+T-cell count was 237 cells/mm3(n=112), and HIV RNA was 4.6 log10copies/ml (n=61). The most common bPIwas lopinavir/ritonavir (83%). At 48 weeks, 61% (79/129) had immune recovery, 60% (26/43) had undetectable HIV RNA and 73% (58/79) had fasting triglycerides ≥130 mg/dl. By 96 weeks, 70% (57/82) achieved immune recovery, 65% (17/26) hadvirological suppression, and hypertriglyceridaemia occurred in 66% (33/50). Predictors for virological suppression at week 48 were longer duration of NNRTI-based HAART (P=0.006), younger age (P=0.007), higher WAZ (P=0.020) and HIV RNA at switch <10,000 copies/ml (P=0.049). Conclusions: In this regional cohort of Asian children on bPI-based second-line HAART, 60% of children tested had immune recovery by 1 year, and two-thirds had hyperlipidaemia, highlighting difficulties in optimizing secondline HAART with limited drug options. © 2013 International Medical Press.
ISSN: 20402058
Appears in Collections:Scopus 2011-2015

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