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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/58111
Title: Impact of low-level viraemia on virological failure among Asian children with perinatally acquired HIV on first-line combination antiretroviral treatment: a multicentre, retrospective cohort study
Authors: Tavitiya Sudjaritruk
Sirinya Teeraananchai
Azar Kariminia
Keswadee Lapphra
Nagalingeswaran Kumarasamy
Moy S. Fong
Rawiwan Hansudewechakul
Torsak Bunupuradah
Penh Sun Ly
Revathy A. Nallusamy
Annette H. Sohn
Virat Sirisanthana
J. Tucker
N. Kumarasamy
C. Ezhilarasi
A. Kinikar
V. Mave
S. Nimkar
N. Kurniati
D. Muktiarti
S. M. Fong
M. Lim
F. Daut
P. Mohamad
T. J. Mohamed
R. Nallusamy
V. Sirisanthana
L. Aurpibul
P. Ounchanum
R. Hansudewechakul
S. Denjanta
A. Kongphonoi
P. Lumbiganon
P. Kosalaraksa
P. Tharnprisan
T. Udomphanit
G. Jourdain
T. Puthanakit
S. Anugulruengkit
W. Jantarabenjakul
R. Nadsasarn
K. Chokephaibulkit
W. Phongsamart
S. Sricharoenchai
K. H. Truong
Q. T. Du
C. H. Nguyen
V. C. Do
T. M. Ha
L. V. Nguyen
D. T.K. Khu
L. T. Nguyen
O. N. Le
A. H. Sohn
J. L. Ross
T. Suwanlerk
M. G. Law
A. Kariminia
VHS Medical Centre India
Thai Red Cross Agency
Kirby Institute
Kasetsart University
Faculty of Medicine, Siriraj Hospital, Mahidol University
Chiang Mai University
National Centre for HIV/AIDS
Foundation for AIDS Research
Penang Hospital
Chiangrai Prachanukroh Hospital
Hospital Likas
Keywords: Medicine
Issue Date: 1-Jul-2020
Citation: Journal of the International AIDS Society. Vol.23, No.7 (2020)
Abstract: © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society Introduction: The clinical relevance of low-level viraemia (LLV) and virological outcomes among children living with HIV (CLHIV) remains controversial. This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first-line combination antiretroviral therapy (cART). Methods: CLHIV aged <18 years, who were on first-line cART for ≥12 months, and had virological suppression (two consecutive plasma viral load [pVL] <50 copies/mL) were included. Those who started treatment with mono/dual antiretroviral therapy, had a history of treatment interruption >14 days, or received treatment and care at sites with a pVL lower limit of detection >50 copies/mL were excluded. LLV was defined as a pVL 50 to 1000 copies/mL, and VF as a single pVL >1000 copies/mL. Baseline was the time of the second pVL < 50 copies/mL. Cox proportional hazards models were performed to assess the association between LLV and VF. Results: From January 2008 to September 2016, 508 CLHIV (55% female) were eligible for the study. At baseline, the median age was 9.6 (IQR: 7.0 to 12.3) years, cART duration was 1.4 (IQR: 1.3 to 1.8) years, 97% of CLHIV were on non-nucleoside reverse transcriptase inhibitor-based regimens, and the median CD4 was 25% (IQR: 20% to 30%). Over a median follow-up time of 6.0 (IQR: 3.1 to 8.9) years from baseline, 86 CLHIV (17%) had ever experienced LLV, of whom 32 (37%) had multiple LLV episodes. Female sex, living in Malaysia (compared to Cambodia), having family members other than biological parents/grandparents as a primary caregiver, and baseline CD4 < 25% increased risk of LLV. Overall, 115 children (23%) developed VF, corresponding to a rate of 4.0 (95%CI: 3.4 to 4.9) per 100 person-years of follow-up (PYFU). VF was greater among children who had ever experienced LLV compared with those who maintained virological suppression throughout the study period (8.9 vs. 3.3 per 100 PYFU; p < 0.001). In multivariable analyses, ever experiencing LLV was associated with increased risk of subsequent VF (adjusted hazard ratio: 3.01; 95%CI: 1.97 to 4.60). Conclusions: LLV increased the risk of subsequent VF among Asian CLHIV who had previously been suppressed on first-line cART. Adherence interventions and additional targeted pVL monitoring may be warranted among children with LLV to facilitate early detection of VF.
URI: http://repository.li.mahidol.ac.th/dspace/handle/123456789/58111
metadata.dc.identifier.url: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85087673360&origin=inward
ISSN: 17582652
Appears in Collections:Scopus 2020

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