We assessed the treatment outcomes on first-line antiretroviral therapy (ART), and factors associated with switching regimen in HIV-infected children treated through the universal coverage health program (UC) in Thailand.
Children aged <15 years at ART initiation who had been receiving ART for at least 6 months between 2008 and 2014 through UC were included in the analysis. The Kaplan–Meier method was used to estimate immunological recovery (IMR), immunological failure, and virological failure (VF). Cox models were used to assess predictors of IMR and VF. Competing risk models were used to assess factors associated with switching to a second-line regimen, with death considered as a competing risk.
A total of 4120 children initiated ART at a median (interquartile range) age of 9.3 (5.8–12.0) years. The median duration of ART was 3.7 years with 17,950 person-years of follow-up. Two thousand eight hundred five children achieved IMR, and the probability of IMR increased to 76% by 3 years after ART initiation. Among 1054 children switched to second-line regimens, 84% had VF and 19% had immunological failure. The cumulative rate of switching regimen increased from 4% to 20% from 1 to 3 years after treatment. Children aged ≥12 years at ART initiation, starting with nonnucleoside reverse-transcriptase inhibitors, and baseline CD4% <10% had an increased risk of switching to second-line regimens.
Children receiving ART through UC had good treatment outcomes, although a fifth required switching regimen by 3 years. Earlier treatment initiation and avoiding nonnucleoside reverse-transcriptase inhibitor first-line regimens in high-risk children may prevent treatment failure.
*HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand;
†Kirby Institute, University of New South Wales, Sydney, Australia;
‡Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
§Research Unit in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand;
‖Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands;
¶Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
#The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand; and
**Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Correspondence to: Kulkanya Chokephaibulkit, MD, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok 10700, Thailand (e-mail: firstname.lastname@example.org).
The Kirby Institute is funded by the Australian Government Department of Health and is affiliated with the Faculty of Medicine, UNSW Australia.
K.R. has received the Senior Research Scholar from Thailand Research Fund (TRF). And he received honoraria or consultation fees from Merck, Roche, Janssen-Cilag, Tibotec, Mylan, and GPO (Government Pharmaceutical Organization, Thailand). He has also participated in a company-sponsored speaker's bureau from Abbott, Gilead, Bristol-Myers Squibb, Merck, Roche, Janssen-Cilag, GlaxoSmithKline, and GPO (Government Pharmaceutical Organization). M.G.L. has received unrestricted research grants from Boehringer Ingelhiem, Gilead Sciences, Merck Sharp & Dohme, Bristol-Myers Squibb, Janssen-Cilag, ViiV HealthCare, DSMB sitting fees from Sirtex Pty Ltd, and consultancy and presentation fees from Gilead Sciences. The remaining authors have no funding or conflicts of interest to disclose.
The content of this publication is solely the responsibility of the authors, and does not necessarily reflect the views of the Australian Government. HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
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Received November 14, 2016
Accepted February 12, 2017