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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. Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance. J Trop Pediatr 2017; 63:135-143. [PMID: 27634175 DOI: 10.1093/tropej/fmw062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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.
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Affiliation(s)
- Ragna S Boerma
- Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.,Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - T Sonia Boender
- Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.,Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.,Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | - Joshua Kayiwa
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Victor Musiime
- Department of Pediatrics and Child Health, Makerere College of Health Sciences, Kampala, Uganda
| | - Andrew Mukuye
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Mary Kiconco
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | | | | | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Kim C E Sigaloff
- Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Division of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Job C J Calis
- Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.,Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
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