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Title: Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia
Authors: Adam W. Bartlett
Pagakrong Lumbiganon
Nia Kurniati
Tavitiya Sudjaritruk
Thahira J. Mohamed
Rawiwan Hansudewechakul
Penh S. Ly
Khanh H. Truong
Thanyawee Puthanakit
Lam V. Nguyen
Kulkanya Chokephaibulkit
Viet C. Do
Nagalingeswaran Kumarasamy
Nik Khairulddin Nik Yusoff
Moy S. Fong
Dewi K. Watu
Revathy Nallusamy
Annette H. Sohn
Matthew G. Law
V. Khol
J. Tucker
E. Chandrasekaran
D. K. Wati
D. Vedaswari
I. B. Ramajaya
D. Muktiarti
M. Lim
F. Daut
P. Mohamad
M. R. Drawis
K. C. Chan
V. Sirisanthana
L. Aurpibul
P. Ounchanum
S. Denjanta
A. Kongphonoi
P. Kosalaraksa
P. Tharnprisan
T. Udomphanit
G. Jourdain
S. Anugulruengkit
W. Jantarabenjakul
R. Nadsasarn
K. Lapphra
W. Phongsamart
S. Sricharoenchai
Q. T. Du
C. H. Nguyen
T. M. Ha
V. T. An
D. T.K. Khu
A. N. Pham
L. T. Nguyen
O. N. Le
J. L. Ross
C. Sethaputra
A. Kariminia
VHS Medical Centre India
National Hospital of Pediatrics Hanoi
Universitas Udayana
Universitas Indonesia
Chulalongkorn University
Kirby Institute
Faculty of Medicine, Khon Kaen University
Kuala Lumpur Hospital
Faculty of Medicine, Siriraj Hospital, Mahidol University
Chiang Mai University
Children's Hospital 2
National Center for HIV/AIDS
Children's Hospital 1
TREAT Asia/amfAR-The Foundation for AIDS Research
Penang Hospital
Chiangrai Prachanukroh Hospital
Hospital Likas
Hospital Raja Perempuan Zainab II
Keywords: Medicine
Issue Date: 1-Nov-2019
Citation: Journal of Adolescent Health. Vol.65, No.5 (2019), 651-659
Abstract: © 2019 Society for Adolescent Health and Medicine Purpose: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. Methods: Regional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. Results: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. Conclusions: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.
ISSN: 18791972
Appears in Collections:Scopus 2019

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