Risk of triple-class virological failure in children with HIV: a retrospective cohort study
Identifieur interne : 002769 ( Pmc/Curation ); précédent : 002768; suivant : 002770Risk of triple-class virological failure in children with HIV: a retrospective cohort study
Auteurs :Source :
- Lancet [ 0140-6736 ] ; 2011.
Abstract
In adults with HIV treated with antiretroviral drug regimens from within the three original drug classes (nucleoside or nucleotide reverse transcriptase inhibitors [NRTIs], non-NRTIs [NNRTIs], and protease inhibitors), virological failure occurs slowly, suggesting that long-term virological suppression can be achieved in most people, even in areas where access is restricted to drugs from these classes. It is unclear whether this is the case for children, the group who will need to maintain viral suppression for longest. We aimed to determine the rate and predictors of triple-class virological failure to the three original drugs classes in children.
In the Collaboration of Observational HIV Epidemiological Research Europe, the rate of triple-class virological failure was studied in children infected perinatally with HIV who were aged less than 16 years, starting antiretroviral therapy (ART) with three or more drugs, between 1998 and 2008. We used Kaplan-Meier and Cox regression methods to investigate the risk and predictors of triple-class virological failure after ART initiation.
Of 1007 children followed up for a median of 4·2 (IQR 2·4–6·5) years, 237 (24%) were triple-class exposed and 105 (10%) had triple-class virological failure, of whom 29 never had a viral-load measurement less than 500 copies per mL. Incidence of triple-class virological failure after ART initiation increased with time, and risk by 5 years after ART initiation was 12·0% (95% CI 9·4–14·6). In multivariate analysis, older age at ART initiation was associated with increased risk of failure (p=0·02). Of 686 children starting ART with NRTIs and either a NNRTI or ritonavir-boosted protease inhibitor, the rate of failure was higher than in adults with heterosexually transmitted HIV (hazard ratio 2·2 [95% CI 1·6–3·0, p<0·0001]).
Findings highlight the challenges of attaining long-term viral suppression in children who will be taking life-long ART. Early identification of children not responding to ART, adherence support, particularly for children and adolescents aged 13 years or older starting ART, and ART simplification strategies are all needed to attain and sustain virological suppression.
Url:
DOI: 10.1016/S0140-6736(11)60208-0
PubMed: 21511330
PubMed Central: 3099443
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: Pour aller vers cette notice dans l'étape Curation :002770
Links to Exploration step
PMC:3099443Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Risk of triple-class virological failure in children with HIV: a retrospective cohort study</title></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21511330</idno><idno type="pmc">3099443</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099443</idno><idno type="RBID">PMC:3099443</idno><idno type="doi">10.1016/S0140-6736(11)60208-0</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002770</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002770</idno><idno type="wicri:Area/Pmc/Curation">002769</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002769</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Risk of triple-class virological failure in children with HIV: a retrospective cohort study</title></analytic><series><title level="j">Lancet</title><idno type="ISSN">0140-6736</idno><idno type="eISSN">1474-547X</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><sec><title>Background</title><p>In adults with HIV treated with antiretroviral drug regimens from within the three original drug classes (nucleoside or nucleotide reverse transcriptase inhibitors [NRTIs], non-NRTIs [NNRTIs], and protease inhibitors), virological failure occurs slowly, suggesting that long-term virological suppression can be achieved in most people, even in areas where access is restricted to drugs from these classes. It is unclear whether this is the case for children, the group who will need to maintain viral suppression for longest. We aimed to determine the rate and predictors of triple-class virological failure to the three original drugs classes in children.</p></sec><sec><title>Methods</title><p>In the Collaboration of Observational HIV Epidemiological Research Europe, the rate of triple-class virological failure was studied in children infected perinatally with HIV who were aged less than 16 years, starting antiretroviral therapy (ART) with three or more drugs, between 1998 and 2008. We used Kaplan-Meier and Cox regression methods to investigate the risk and predictors of triple-class virological failure after ART initiation.</p></sec><sec><title>Findings</title><p>Of 1007 children followed up for a median of 4·2 (IQR 2·4–6·5) years, 237 (24%) were triple-class exposed and 105 (10%) had triple-class virological failure, of whom 29 never had a viral-load measurement less than 500 copies per mL. Incidence of triple-class virological failure after ART initiation increased with time, and risk by 5 years after ART initiation was 12·0% (95% CI 9·4–14·6). In multivariate analysis, older age at ART initiation was associated with increased risk of failure (p=0·02). Of 686 children starting ART with NRTIs and either a NNRTI or ritonavir-boosted protease inhibitor, the rate of failure was higher than in adults with heterosexually transmitted HIV (hazard ratio 2·2 [95% CI 1·6–3·0, p<0·0001]).</p></sec><sec><title>Interpretation</title><p>Findings highlight the challenges of attaining long-term viral suppression in children who will be taking life-long ART. Early identification of children not responding to ART, adherence support, particularly for children and adolescents aged 13 years or older starting ART, and ART simplification strategies are all needed to attain and sustain virological suppression.</p></sec><sec><title>Funding</title><p><funding-source id="GS1">UK Medical Research Council</funding-source> award G0700832.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Judd, A" uniqKey="Judd A">A Judd</name></author><author><name sortKey="Doerholt, K" uniqKey="Doerholt K">K Doerholt</name></author><author><name sortKey="Tookey, Pa" uniqKey="Tookey P">PA Tookey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brady, Mt" uniqKey="Brady M">MT Brady</name></author><author><name sortKey="Oleske, Jm" uniqKey="Oleske J">JM Oleske</name></author><author><name sortKey="Williams, Pl" uniqKey="Williams P">PL Williams</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Demartino, M" uniqKey="Demartino M">M deMartino</name></author><author><name sortKey="Tovo, Pa" uniqKey="Tovo P">PA Tovo</name></author><author><name sortKey="Balducci, M" uniqKey="Balducci M">M Balducci</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharland, M" uniqKey="Sharland M">M Sharland</name></author><author><name sortKey="Blanche, S" uniqKey="Blanche S">S Blanche</name></author><author><name sortKey="Castelli, G" uniqKey="Castelli G">G Castelli</name></author><author><name sortKey="Ramos, J" uniqKey="Ramos J">J Ramos</name></author><author><name sortKey="Gibb, Dm" uniqKey="Gibb D">DM Gibb</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Violari, A" uniqKey="Violari A">A Violari</name></author><author><name sortKey="Cotton, Mf" uniqKey="Cotton M">MF Cotton</name></author><author><name sortKey="Gibb, Dm" uniqKey="Gibb D">DM Gibb</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goetghebuer, T" uniqKey="Goetghebuer T">T Goetghebuer</name></author><author><name sortKey="Haelterman, E" uniqKey="Haelterman E">E Haelterman</name></author><author><name sortKey="Le Chenadec, J" uniqKey="Le Chenadec J">J Le Chenadec</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Welch, S" uniqKey="Welch S">S Welch</name></author><author><name sortKey="Sharland, M" uniqKey="Sharland M">M Sharland</name></author><author><name sortKey="Lyall, Eg" uniqKey="Lyall E">EG Lyall</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Paterson, Dl" uniqKey="Paterson D">DL Paterson</name></author><author><name sortKey="Swindells, S" uniqKey="Swindells S">S Swindells</name></author><author><name sortKey="Mohr, J" uniqKey="Mohr J">J Mohr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nachega, Jb" uniqKey="Nachega J">JB Nachega</name></author><author><name sortKey="Hislop, M" uniqKey="Hislop M">M Hislop</name></author><author><name sortKey="Dowdy, Dw" uniqKey="Dowdy D">DW Dowdy</name></author><author><name sortKey="Chaisson, Re" uniqKey="Chaisson R">RE Chaisson</name></author><author><name sortKey="Regensberg, L" uniqKey="Regensberg L">L Regensberg</name></author><author><name sortKey="Maartens, G" uniqKey="Maartens G">G Maartens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bangsberg, Dr" uniqKey="Bangsberg D">DR Bangsberg</name></author><author><name sortKey="Kroetz, Dl" uniqKey="Kroetz D">DL Kroetz</name></author><author><name sortKey="Deeks, Sg" uniqKey="Deeks S">SG Deeks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deeks, Sg" uniqKey="Deeks S">SG Deeks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reddington, C" uniqKey="Reddington C">C Reddington</name></author><author><name sortKey="Cohen, J" uniqKey="Cohen J">J Cohen</name></author><author><name sortKey="Baldillo, A" uniqKey="Baldillo A">A Baldillo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martin, S" uniqKey="Martin S">S Martin</name></author><author><name sortKey="Elliott Desorbo, Dk" uniqKey="Elliott Desorbo D">DK Elliott-DeSorbo</name></author><author><name sortKey="Wolters, Pl" uniqKey="Wolters P">PL Wolters</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murphy, Da" uniqKey="Murphy D">DA Murphy</name></author><author><name sortKey="Belzer, M" uniqKey="Belzer M">M Belzer</name></author><author><name sortKey="Durako, Sj" uniqKey="Durako S">SJ Durako</name></author><author><name sortKey="Sarr, M" uniqKey="Sarr M">M Sarr</name></author><author><name sortKey="Wilson, Cm" uniqKey="Wilson C">CM Wilson</name></author><author><name sortKey="Muenz, Lr" uniqKey="Muenz L">LR Muenz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Menson, En" uniqKey="Menson E">EN Menson</name></author><author><name sortKey="Walker, As" uniqKey="Walker A">AS Walker</name></author><author><name sortKey="Sharland, M" uniqKey="Sharland M">M Sharland</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Havens, Pl" uniqKey="Havens P">PL Havens</name></author><author><name sortKey="Gibb, Dm" uniqKey="Gibb D">DM Gibb</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kjaer, J" uniqKey="Kjaer J">J Kjaer</name></author><author><name sortKey="Ledergerber, B" uniqKey="Ledergerber B">B Ledergerber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walker, As" uniqKey="Walker A">AS Walker</name></author><author><name sortKey="Doerholt, K" uniqKey="Doerholt K">K Doerholt</name></author><author><name sortKey="Sharland, M" uniqKey="Sharland M">M Sharland</name></author><author><name sortKey="Gibb, Dm" uniqKey="Gibb D">DM Gibb</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Va" uniqKey="Johnson V">VA Johnson</name></author><author><name sortKey="Brun Vezinet, F" uniqKey="Brun Vezinet F">F Brun-Vezinet</name></author><author><name sortKey="Clotet, B" uniqKey="Clotet B">B Clotet</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kekitiinwa, A" uniqKey="Kekitiinwa A">A Kekitiinwa</name></author><author><name sortKey="Lee, Kj" uniqKey="Lee K">KJ Lee</name></author><author><name sortKey="Walker, As" uniqKey="Walker A">AS Walker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Giaquinto, C" uniqKey="Giaquinto C">C Giaquinto</name></author><author><name sortKey="Morelli, E" uniqKey="Morelli E">E Morelli</name></author><author><name sortKey="Fregonese, F" uniqKey="Fregonese F">F Fregonese</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mills, Ej" uniqKey="Mills E">EJ Mills</name></author><author><name sortKey="Nachega, Jb" uniqKey="Nachega J">JB Nachega</name></author><author><name sortKey="Buchan, I" uniqKey="Buchan I">I Buchan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ledergerber, B" uniqKey="Ledergerber B">B Ledergerber</name></author><author><name sortKey="Lundgren, Jd" uniqKey="Lundgren J">JD Lundgren</name></author><author><name sortKey="Walker, As" uniqKey="Walker A">AS Walker</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet</journal-id><journal-id journal-id-type="iso-abbrev">Lancet</journal-id><journal-title-group><journal-title>Lancet</journal-title></journal-title-group><issn pub-type="ppub">0140-6736</issn><issn pub-type="epub">1474-547X</issn><publisher><publisher-name>Lancet Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21511330</article-id><article-id pub-id-type="pmc">3099443</article-id><article-id pub-id-type="publisher-id">LANCET60208</article-id><article-id pub-id-type="doi">10.1016/S0140-6736(11)60208-0</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Risk of triple-class virological failure in children with HIV: a retrospective cohort study</article-title></title-group><contrib-group><contrib contrib-type="author"><collab>The Pursuing Later Treatment Options II (PLATO II) project team for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE)</collab><xref rid="fn1" ref-type="fn">‡</xref></contrib></contrib-group><author-notes><fn id="fn1"><label>‡</label><p>Members listed at end of paper</p></fn></author-notes><pub-date pub-type="pmc-release"><day>7</day><month>5</month><year>2011</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<pub-date pub-type="ppub"><day>7</day><month>5</month><year>2011</year></pub-date><volume>377</volume><issue>9777</issue><fpage>1580</fpage><lpage>1587</lpage><permissions><copyright-statement>© 2011 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2011</copyright-year><copyright-holder>Elsevier Ltd</copyright-holder><license><license-p>This document may be redistributed and reused, subject to <ext-link ext-link-type="uri" xlink:href="http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms1.0">certain conditions</ext-link>.</license-p></license></permissions><abstract><title>Summary</title><sec><title>Background</title><p>In adults with HIV treated with antiretroviral drug regimens from within the three original drug classes (nucleoside or nucleotide reverse transcriptase inhibitors [NRTIs], non-NRTIs [NNRTIs], and protease inhibitors), virological failure occurs slowly, suggesting that long-term virological suppression can be achieved in most people, even in areas where access is restricted to drugs from these classes. It is unclear whether this is the case for children, the group who will need to maintain viral suppression for longest. We aimed to determine the rate and predictors of triple-class virological failure to the three original drugs classes in children.</p></sec><sec><title>Methods</title><p>In the Collaboration of Observational HIV Epidemiological Research Europe, the rate of triple-class virological failure was studied in children infected perinatally with HIV who were aged less than 16 years, starting antiretroviral therapy (ART) with three or more drugs, between 1998 and 2008. We used Kaplan-Meier and Cox regression methods to investigate the risk and predictors of triple-class virological failure after ART initiation.</p></sec><sec><title>Findings</title><p>Of 1007 children followed up for a median of 4·2 (IQR 2·4–6·5) years, 237 (24%) were triple-class exposed and 105 (10%) had triple-class virological failure, of whom 29 never had a viral-load measurement less than 500 copies per mL. Incidence of triple-class virological failure after ART initiation increased with time, and risk by 5 years after ART initiation was 12·0% (95% CI 9·4–14·6). In multivariate analysis, older age at ART initiation was associated with increased risk of failure (p=0·02). Of 686 children starting ART with NRTIs and either a NNRTI or ritonavir-boosted protease inhibitor, the rate of failure was higher than in adults with heterosexually transmitted HIV (hazard ratio 2·2 [95% CI 1·6–3·0, p<0·0001]).</p></sec><sec><title>Interpretation</title><p>Findings highlight the challenges of attaining long-term viral suppression in children who will be taking life-long ART. Early identification of children not responding to ART, adherence support, particularly for children and adolescents aged 13 years or older starting ART, and ART simplification strategies are all needed to attain and sustain virological suppression.</p></sec><sec><title>Funding</title><p><funding-source id="GS1">UK Medical Research Council</funding-source> award G0700832.</p></sec></abstract></article-meta></front><floats-group><fig id="fig1"><label>Figure 1</label><caption><p>Inclusion criteria for initial regimens and definition of triple-class virological failure in the main analysis and the comparison of children with adults</p><p>TCVF=triple-class virological failure. NRTI=nucleoside or nucleotide reverse transcriptase inhibitors. NNRTI=non-NRTI. PI/r=ritonavir-boosted protease inhibitor. PI=protease inhibitor. uPI=unboosted protease inhibitor.</p></caption><graphic xlink:href="gr1"></graphic></fig><fig id="fig2"><label>Figure 2</label><caption><p>Incidence per 100 person-years (95% CI) of triple-class virological failure in children with HIV by duration of antiretroviral therapy</p><p>*At end of year 9.</p></caption><graphic xlink:href="gr2"></graphic></fig><table-wrap id="tbl1" position="float"><label>Table 1</label><caption><p>Characteristics of children at the time of antiretroviral therapy initiation</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th align="left"><bold>Number of children (n=1007)</bold></th><th align="left"><bold>Median follow-up person-years</bold></th></tr></thead><tbody><tr><td colspan="3" align="left"><bold>Sex</bold></td></tr><tr><td align="left">Boy</td><td align="left">510 (51%)</td><td align="left">3·9</td></tr><tr><td align="left">Girl</td><td align="left">497 (50%)</td><td align="left">3·6</td></tr><tr><td colspan="3" align="left"><bold>Age at start of ART (years)</bold></td></tr><tr><td align="left"><2</td><td align="left">350 (35%)</td><td align="left">4·1</td></tr><tr><td align="left">2–4</td><td align="left">202 (20%)</td><td align="left">4·3</td></tr><tr><td align="left">5–9</td><td align="left">265 (26%)</td><td align="left">4·0</td></tr><tr><td align="left">10–15</td><td align="left">190 (19%)</td><td align="left">2·9</td></tr><tr><td align="left">Median (IQR)</td><td align="left">4·2 (0·9–8·5)</td><td align="left">..</td></tr><tr><td colspan="3" align="left"><bold>Year of ART initiation</bold></td></tr><tr><td align="left">1998–2000</td><td align="left">368 (37%)</td><td align="left">6·8</td></tr><tr><td align="left">2001–2003</td><td align="left">363 (36%)</td><td align="left">3·9</td></tr><tr><td align="left">2004–2007</td><td align="left">276 (27%)</td><td align="left">1·7</td></tr><tr><td colspan="3" align="left"><bold>Previous ART exposure for prevention of mother-to-child transmission</bold><xref rid="tbl1fn1" ref-type="table-fn">*</xref></td></tr><tr><td align="left">No</td><td align="left">937 (93%)</td><td align="left">3·9</td></tr><tr><td align="left">Yes</td><td align="left">70 (7%)</td><td align="left">3·1</td></tr><tr><td colspan="3" align="left"><bold>Initial regimen</bold></td></tr><tr><td align="left">NNRTI + 2 NRTIs</td><td align="left">467 (46%)</td><td align="left">3·0</td></tr><tr><td align="left">NNRTI + 3 NRTIs</td><td align="left">93 (9%)</td><td align="left">3·9</td></tr><tr><td align="left">Ritonavir-boosted protease inhibitor + 2 or 3 NRTIs</td><td align="left">126 (13%)</td><td align="left">3·0</td></tr><tr><td align="left">Unboosted protease inhibitor + 2 or 3 NRTIs</td><td align="left">270 (27%)</td><td align="left">6·7</td></tr><tr><td align="left">3 NRTIs</td><td align="left">51 (5%)</td><td align="left">4·8</td></tr><tr><td colspan="3" align="left"><bold>AIDS diagnosis before ART initiation</bold></td></tr><tr><td align="left">No</td><td align="left">793 (79%)</td><td align="left">3·7</td></tr><tr><td align="left">Yes</td><td align="left">214 (21%)</td><td align="left">4·1</td></tr><tr><td colspan="3" align="left"><bold>CD4 percentage at ART initiation</bold></td></tr><tr><td align="left">0–9%</td><td align="left">193 (19%)</td><td align="left">3·8</td></tr><tr><td align="left">10–19%</td><td align="left">254 (25%)</td><td align="left">3·2</td></tr><tr><td align="left">≥20%</td><td align="left">236 (23%)</td><td align="left">4·3</td></tr><tr><td align="left">Unknown</td><td align="left">324 (32%)</td><td align="left">4·0</td></tr><tr><td align="left">Median (IQR)</td><td align="left">15·0 (9–24)</td><td align="left">..</td></tr><tr><td colspan="3" align="left"><bold>Viral load at ART initiation (log</bold><sub>10</sub><bold>copies per mL)</bold></td></tr><tr><td align="left">0–4·49</td><td align="left">181 (18%)</td><td align="left">3·3</td></tr><tr><td align="left">4·50-5·49</td><td align="left">334 (33%)</td><td align="left">3·4</td></tr><tr><td align="left">≥5·50</td><td align="left">258 (26%)</td><td align="left">4·2</td></tr><tr><td align="left">Unknown</td><td align="left">234 (23%)</td><td align="left">4·1</td></tr><tr><td align="left">Median (IQR)</td><td align="left">5·1 (4·6–5·7)</td><td align="left">..</td></tr></tbody></table><table-wrap-foot><fn><p>ART=antiretroviral therapy. IQR=inter-quartile range. NRTI=nucleoside or nucleotide reverse transcriptase inhibitors. NNRTI=non-NRTI.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn1"><label>*</label><p>Antiretroviral therapy (ART) for prevention of mother-to-child transmission was defined as one or two antiretrovirals initiated within 7 days of birth and stopped up to 60 days after, or three or more antiretrovirals initiated within 7 days of birth and stopped up to 60 days after, and then no antiretrovirals for at least 90 days.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tbl2" position="float"><label>Table 2</label><caption><p>Predictors of triple class virological failure</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th colspan="3" align="left"><bold>Univariate analyses</bold><hr></hr></th><th colspan="3" align="left"><bold>Multivariate analyses</bold><hr></hr></th></tr><tr><th></th><th align="left">Hazard ratio</th><th align="left">95% CI</th><th align="left">p</th><th align="left">Hazard ratio</th><th align="left">95% CI</th><th align="left">p</th></tr></thead><tbody><tr><td colspan="7" align="left"><bold>Sex</bold></td></tr><tr><td align="left">Boy</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·96</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·92</td></tr><tr><td align="left">Girl</td><td align="left">1·0</td><td align="left">0·7–1·5</td><td align="left">..</td><td align="left">1·0</td><td align="left">0·7–1·5</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>Age at start of ART (years)</bold></td></tr><tr><td align="left"><2</td><td align="left">1·2</td><td align="left">0·7–2·0</td><td align="left">0·03</td><td align="left">1·2</td><td align="left">0·7–2·0</td><td align="left">0·02</td></tr><tr><td align="left">2–4</td><td align="left">0·9</td><td align="left">0·5–1·7</td><td align="left">..</td><td align="left">0·9</td><td align="left">0·5–1·7</td><td align="left">..</td></tr><tr><td align="left">5–9</td><td align="left">1·0</td><td align="left">..</td><td align="left">..</td><td align="left">1·0</td><td align="left">..</td><td align="left">..</td></tr><tr><td align="left">10–15</td><td align="left">2·1</td><td align="left">1·2–3·7</td><td align="left">..</td><td align="left">2·3</td><td align="left">1·2–4·1</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>Year of ART initiation</bold></td></tr><tr><td align="left">1998–2000</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·46</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·83</td></tr><tr><td align="left">2001–2003</td><td align="left">0·7</td><td align="left">0·5–1·2</td><td align="left">..</td><td align="left">0·9</td><td align="left">0·5–1·5</td><td align="left">..</td></tr><tr><td align="left">2004–2007</td><td align="left">0·9</td><td align="left">0·4–2·0</td><td align="left">..</td><td align="left">1·0</td><td align="left">0·4–2·4</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>Initial regimen</bold></td></tr><tr><td align="left">NNRTI+2 NRTIs</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·46</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·24</td></tr><tr><td align="left">NNRTI+3 NRTIs</td><td align="left">0·7</td><td align="left">0·3–1·6</td><td align="left">..</td><td align="left">0·7</td><td align="left">0·3–1·6</td><td align="left">..</td></tr><tr><td align="left">Ritonavir-boosted protease inhibitor + 2 or 3 NRTIs</td><td align="left">0·5</td><td align="left">0·2–1·4</td><td align="left">..</td><td align="left">0·4</td><td align="left">0·1–1·3</td><td align="left">..</td></tr><tr><td align="left">Unboosted protease inhibitor + 2 or 3 NRTIs</td><td align="left">1·1</td><td align="left">0·7–1·7</td><td align="left">..</td><td align="left">1·1</td><td align="left">0·7–1·7</td><td align="left">..</td></tr><tr><td align="left">3 NRTIs</td><td align="left">0·8</td><td align="left">0·3–2·1</td><td align="left">..</td><td align="left">0·8</td><td align="left">0·3–2·0</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>Previous ART exposure for prevention of mother-to-child transmission</bold></td></tr><tr><td align="left">No or unknown</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·91</td><td align="left">..</td><td align="left">..</td><td align="left">0·64</td></tr><tr><td align="left">Yes</td><td align="left">1·0</td><td align="left">0·4–2·3</td><td align="left">..</td><td align="left">1·3</td><td align="left">0·5–3·4</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>AIDS diagnosis before ART initiation</bold></td></tr><tr><td align="left">No</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·18</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·12</td></tr><tr><td align="left">Yes</td><td align="left">1·3</td><td align="left">0·9–2·1</td><td align="left">..</td><td align="left">1·4</td><td align="left">0·9–2·3</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>CD4 percentage at ART initiation</bold></td></tr><tr><td align="left">0–9%</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·61</td><td align="left">1·0</td><td align="left">..</td><td align="left">0·73</td></tr><tr><td align="left">10–19%</td><td align="left">0·9</td><td align="left">0·5–1·7</td><td align="left">..</td><td align="left">1·0</td><td align="left">0·6–1·9</td><td align="left">..</td></tr><tr><td align="left">≥20%</td><td align="left">0·8</td><td align="left">0·4–1·5</td><td align="left">..</td><td align="left">0·9</td><td align="left">0·5–1·8</td><td align="left">..</td></tr><tr><td align="left">Unknown</td><td align="left">1·1</td><td align="left">0·7–1·9</td><td align="left">..</td><td align="left">1·3</td><td align="left">0·7–2·4</td><td align="left">..</td></tr><tr><td colspan="7" align="left"><bold>Viral load at ART initiation (log</bold><sub>10</sub><bold>copies per mL)</bold></td></tr><tr><td align="left">0–4·49</td><td align="left">0·65</td><td align="left">0·3–1·2</td><td align="left">0·58</td><td align="left">0·5</td><td align="left">0·3–1·0</td><td align="left">0·24</td></tr><tr><td align="left">4·50–5·49</td><td align="left">1·0</td><td align="left">..</td><td align="left">..</td><td align="left">1·0</td><td align="left">..</td><td align="left">..</td></tr><tr><td align="left">≥5·50</td><td align="left">1·0</td><td align="left">0·6–1·6</td><td align="left">..</td><td align="left">0·9</td><td align="left">0·5–1·6</td><td align="left">..</td></tr><tr><td align="left">Unknown</td><td align="left">1·0</td><td align="left">0·6–1·6</td><td align="left">..</td><td align="left">0·7</td><td align="left">0·4–1·3</td><td align="left">..</td></tr></tbody></table><table-wrap-foot><fn><p>ART=antiretroviral therapy. NRTI=nucleoside or nucleotide reverse transcriptase inhibitors. NNRTI=non-NRTI.</p></fn></table-wrap-foot></table-wrap><boxed-text id="box1"><label>Panel</label><caption><title>Research in context</title></caption><p><bold>Systematic review</bold></p><p>Although reports of paediatric cohort studies have described triple-class virological failure among small numbers of children, no large cohort or cohort collaboration has undertaken a formal assessment of the incidence or consequences of triple-class failure and no randomised trials of children with triple-class failure have been done.</p><p><bold>Interpretation</bold></p><p>Our study shows that the rate of development of triple-class virological failure in children with HIV in Europe is low, which supports the high efficacy of these drugs in children, but the rate is higher than in adults. These children will be receiving antiretroviral therapy for an entire lifetime, and these findings highlight the challenges in attainment of long-term viral suppression. Early identification of non-responders, adherence support, especially for older children and young people aged 13 years or older starting antiretroviral therapy, and simplification of antiretroviral strategies are all needed to attain and sustain virological suppression.</p></boxed-text></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Curation
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002769 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Curation/biblio.hfd -nk 002769 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Curation
|type= RBID
|clé= PMC:3099443
|texte= Risk of triple-class virological failure in children with HIV: a retrospective cohort study
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Curation/RBID.i -Sk "pubmed:21511330" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Curation/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
| This area was generated with Dilib version V0.6.32. |  |