Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance

Ragna S Boerma; Cissy Kityo; T Sonia Boender; Elizabeth Kaudha; Joshua Kayiwa; Victor Musiime; Andrew Mukuye; Mary Kiconco; Immaculate Nankya; Lilian Nakatudde; Peter N Mugyenyi; Michael Boele van Hensbroek; Tobias F Rinke de Wit; Kim C E Sigaloff; Job C J Calis

doi:https://doi.org/10.1093/tropej/fmw062

Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance

Ragna S Boerma, Cissy Kityo, T Sonia Boender, Elizabeth Kaudha, Joshua Kayiwa, Victor Musiime, Andrew Mukuye, Mary Kiconco, Immaculate Nankya, Lilian Nakatudde, Peter N Mugyenyi, Michael Boele van Hensbroek, Tobias F Rinke de Wit, Kim C E Sigaloff, Job C J Calis

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.

METHODS: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.

RESULTS: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.

CONCLUSIONS: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.

Original language	English
Pages (from-to)	135-143
Number of pages	9
Journal	Journal of tropical pediatrics
Volume	63
Issue number	2
DOIs	https://doi.org/10.1093/tropej/fmw062
Publication status	Published - 1 Apr 2017

Keywords

Adolescent
Anti-Retroviral Agents/pharmacology
Black People/statistics & numerical data
Child
Child, Preschool
Cohort Studies
Drug Resistance, Viral
Female
HIV Infections/drug therapy
HIV Protease Inhibitors/therapeutic use
HIV-1/drug effects
Humans
Male
Mutation
Prevalence
Treatment Failure
Treatment Outcome
Uganda
Viral Load

Access to Document

https://doi.org/10.1093/tropej/fmw062

Cite this

Boerma, R. S., Kityo, C., Boender, T. S., Kaudha, E., Kayiwa, J., Musiime, V., Mukuye, A., Kiconco, M., Nankya, I., Nakatudde, L., Mugyenyi, P. N., Boele van Hensbroek, M., Rinke de Wit, T. F., Sigaloff, K. C. E., & Calis, J. C. J. (2017). Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance. Journal of tropical pediatrics, 63(2), 135-143. https://doi.org/10.1093/tropej/fmw062

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title = "Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance",

abstract = "BACKGROUND: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.METHODS: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.RESULTS: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.CONCLUSIONS: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.",

keywords = "Adolescent, Anti-Retroviral Agents/pharmacology, Black People/statistics & numerical data, Child, Child, Preschool, Cohort Studies, Drug Resistance, Viral, Female, HIV Infections/drug therapy, HIV Protease Inhibitors/therapeutic use, HIV-1/drug effects, Humans, Male, Mutation, Prevalence, Treatment Failure, Treatment Outcome, Uganda, Viral Load",

author = "Boerma, {Ragna S} and Cissy Kityo and Boender, {T Sonia} and Elizabeth Kaudha and Joshua Kayiwa and Victor Musiime and Andrew Mukuye and Mary Kiconco and Immaculate Nankya and Lilian Nakatudde and Mugyenyi, {Peter N} and {Boele van Hensbroek}, Michael and {Rinke de Wit}, {Tobias F} and Sigaloff, {Kim C E} and Calis, {Job C J}",

year = "2017",

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Boerma, RS, Kityo, C, Boender, TS, Kaudha, E, Kayiwa, J, Musiime, V, Mukuye, A, Kiconco, M, Nankya, I, Nakatudde, L, Mugyenyi, PN, Boele van Hensbroek, M, Rinke de Wit, TF, Sigaloff, KCE & Calis, JCJ 2017, 'Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance', Journal of tropical pediatrics, vol. 63, no. 2, pp. 135-143. https://doi.org/10.1093/tropej/fmw062

TY - JOUR

T1 - Second-line HIV Treatment in Ugandan Children

T2 - Favorable Outcomes and No Protease Inhibitor Resistance

AU - Boerma, Ragna S

AU - Kityo, Cissy

AU - Boender, T Sonia

AU - Kaudha, Elizabeth

AU - Kayiwa, Joshua

AU - Musiime, Victor

AU - Mukuye, Andrew

AU - Kiconco, Mary

AU - Nankya, Immaculate

AU - Nakatudde, Lilian

AU - Mugyenyi, Peter N

AU - Boele van Hensbroek, Michael

AU - Rinke de Wit, Tobias F

AU - Sigaloff, Kim C E

AU - Calis, Job C J

PY - 2017/4/1

Y1 - 2017/4/1

N2 - BACKGROUND: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.METHODS: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.RESULTS: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.CONCLUSIONS: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.

AB - BACKGROUND: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.METHODS: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.RESULTS: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.CONCLUSIONS: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.

KW - Adolescent

KW - Anti-Retroviral Agents/pharmacology

KW - Black People/statistics & numerical data

KW - Child

KW - Child, Preschool

KW - Cohort Studies

KW - Drug Resistance, Viral

KW - Female

KW - HIV Infections/drug therapy

KW - HIV Protease Inhibitors/therapeutic use

KW - HIV-1/drug effects

KW - Humans

KW - Male

KW - Mutation

KW - Prevalence

KW - Treatment Failure

KW - Treatment Outcome

KW - Uganda

KW - Viral Load

U2 - https://doi.org/10.1093/tropej/fmw062

DO - https://doi.org/10.1093/tropej/fmw062

M3 - Article

C2 - 27634175

SN - 0142-6338

VL - 63

SP - 135

EP - 143

JO - Journal of tropical pediatrics

JF - Journal of tropical pediatrics

IS - 2

ER -