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Antiretroviral Treatment Strategies in Highly Treatment Experienced Perinatally HIV-infected Youth

Wong, Frances L. PharmD, MEd, MPH, BCPS*; Hsu, Alice J. PharmD, BCPS, AQ-ID; Pham, Paul A. PharmD, BCPS†‡; Siberry, George K. MD, MPH§; Hutton, Nancy MD; Agwu, Allison L. MD, ScM

Pediatric Infectious Disease Journal: December 2012 - Volume 31 - Issue 12 - p 1279–1283
doi: 10.1097/INF.0b013e31826fd3e7
HIV Reports

Background: There is limited information on antiretroviral (ARV) regimens and outcomes in perinatally HIV (PHIV)-infected youth. Substantial drug resistance after long-term ARV use and nonadherence hinder efforts to design suppressive regimens for PHIV-infected youth. This study compares clinical outcomes by expected activity of the prescribed ARV regimens.

Methods: A retrospective cohort study of 13- to 24-year-old PHIV-infected youth on stable ARV regimens for ≥6 months was conducted at a pediatric HIV clinic. ARV regimens were retrospectively categorized as optimal or suboptimal based on accumulated genotypic resistance before study regimen initiation.

Results: Fifty-two patients with similar baseline characteristics met inclusion criteria (21 optimal and 31 suboptimal regimens). Patients receiving optimal regimens had significantly higher increases in CD4 than those given suboptimal regimens by week 48 of treatment (+62 versus +8 cells/mm3, respectively; P = 0.04) and by the end of study period (+93 versus −1 cells/mm3, respectively; P = 0.03). There were no significant differences between the groups in decline of viral load, frequency of opportunistic infections or hospitalizations or accumulation of resistance mutations. Overall, 60% of the optimal and 45% of the suboptimal groups had nonadherence during the study regimen (P = 0.3).

Conclusions: PHIV-infected youth receiving optimal regimens had greater CD4 improvements but no difference in virologic outcomes compared with those receiving suboptimal regimens. In a patient population with significant nonadherence, providers must weigh the immunologic benefits of initiating an optimal regimen versus the potential risks of further resistance accumulation limiting future treatment options.

From the *Kaiser Permanente Fontana Medical Center, Fontana, CA; Department of Pharmacy, The Johns Hopkins Hospital; Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD; §Pediatric Adolescent Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; Department of Pediatrics, Division of General Pediatrics; and Division of Pediatric Infectious Diseases, The Johns Hopkins University, Baltimore, MD.

Accepted for publication July 18, 2012.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institutes of Health or the Department of Health and Human Services.

This study was presented at the 30th Eastern States Conference, May 2011, in Hershey, PA.

ALA is supported by The Johns Hopkins Ross Clinician Scientist Award and the National Institutes of Allergy and Infectious Diseases (1K23 AI084549). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Allison L. Agwu, MD, ScM, Division of Pediatric Infectious Diseases, The Johns Hopkins University, 200 North Wolfe Street, Room 3145, Baltimore, MD 21287. E-mail: ageorg10@jhmi.edu.

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© 2012 Lippincott Williams & Wilkins, Inc.