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Title: Impact of the frequency of plasma viral load monitoring on treatment outcomes among children with perinatally acquired HIV
Authors: Tavitiya Sudjaritruk
David C. Boettiger
Lam Van Nguyen
Thahira J. Mohamed
Dewi K. Wati
Torsak Bunupuradah
Rawiwan Hansudewechakul
Penh S. Ly
Pagakrong Lumbiganon
Revathy A. Nallusamy
Moy S. Fong
Kulkanya Chokephaibulkit
Nik K. Nik Yusoff
Khanh H. Truong
Viet C. Do
Annette H. Sohn
Virat Sirisanthana
J. Tucker
N. Kumarasamy
E. Chandrasekaran
D. Vedaswari
I. B. Ramajaya
N. Kurniati
D. Muktiarti
M. Lim
F. Daut
P. Mohamad
M. R. Drawis
K. C. Chan
L. Aurpibul
P. Ounchanum
S. Denjanta
A. Kongphonoi
P. Kosalaraksa
P. Tharnprisan
T. Udomphanit
G. Jourdain
T. Puthanakit
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
Ho Chi
J. L. Ross
T. Suwanlerk
M. G. Law
A. Kariminia
National Hospital of Pediatrics Hanoi
Universitas Udayana
Kirby Institute
Faculty of Medicine, Khon Kaen University
Kuala Lumpur Hospital
The HIV Netherlands Australia Thailand Research Collaboration
Faculty of Medicine, Siriraj Hospital, Mahidol University
Chiang Mai University
Children's Hospital 2
National Center for HIV/AIDS
Children's Hospital 1
Foundation for AIDS Research
Chiangrai Prachanukroh Hospital
Hospital Likas
Hospital Raja Perempuan Zainab II
Penang Hospital
Keywords: Medicine
Issue Date: 1-Jun-2019
Citation: Journal of the International AIDS Society. Vol.22, No.6 (2019)
Abstract: © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Introduction: Recommendations on the optimal frequency of plasma viral load (pVL) monitoring in children living with HIV (CLWH) who are stable on combination antiretroviral therapy (cART) are inconsistent. This study aimed to determine the impact of annual versus semi-annual pVL monitoring on treatment outcomes in Asian CLWH. Methods: Data on children with perinatally acquired HIV aged <18 years on first-line, non-nucleoside reverse transcriptase inhibitor-based cART with viral suppression (two consecutive pVL <400 copies/mL over a six-month period) were included from a regional cohort study; those exposed to prior mono- or dual antiretroviral treatment were excluded. Frequency of pVL monitoring was determined at the site-level based on the median rate of pVL measurement: annual 0.75 to 1.5, and semi-annual >1.5 tests/patient/year. Treatment failure was defined as virologic failure (two consecutive pVL >1000 copies/mL), change of antiretroviral drug class, or death. Baseline was the date of the second consecutive pVL <400 copies/mL. Competing risk regression models were used to identify predictors of treatment failure. Results: During January 2008 to March 2015, there were 1220 eligible children from 10 sites that performed at least annual pVL monitoring, 1042 (85%) and 178 (15%) were from sites performing annual (n = 6) and semi-annual pVL monitoring (n = 4) respectively. Pre-cART, 675 children (55%) had World Health Organization clinical stage 3 or 4, the median nadir CD4 percentage was 9%, and the median pVL was 5.2 log10 copies/mL. At baseline, the median age was 9.2 years, 64% were on nevirapine-based regimens, the median cART duration was 1.6 years, and the median CD4 percentage was 26%. Over the follow-up period, 258 (25%) CLWH with annual and 40 (23%) with semi-annual pVL monitoring developed treatment failure, corresponding to incidence rates of 5.4 (95% CI: 4.8 to 6.1) and 4.3 (95% CI: 3.1 to 5.8) per 100 patient-years of follow-up respectively (p = 0.27). In multivariable analyses, the frequency of pVL monitoring was not associated with treatment failure (adjusted hazard ratio: 1.12; 95% CI: 0.80 to 1.59). Conclusions: Annual compared to semi-annual pVL monitoring was not associated with an increased risk of treatment failure in our cohort of virally suppressed children with perinatally acquired HIV on first-line NNRTI-based cART.
ISSN: 17582652
Appears in Collections:Scopus 2019

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