Time to switch to second-line antiretroviral therapy in children with human immunodeficiency virus in Europe and Thailand. Clinical Infectious Disease
Collins et al. on behalf of the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord aimed to assess time to switch to second-line antiretroviral therapy (ART) for any cause and associated factors in the context of routine viral load (VL) monitoring among cohorts across 16 European countries and Thailand. Children aged
Of 3’668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7–10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%–23%), with significant regional variations. Median time to switch was 30 (IQR, 16–58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher VL at ART start, and NVP-based initial regimens were associated with increased risk of switch.
In conclusion, in this cohort of children with routine VL monitoring, a fifth had switched to second-line ART whereas the large majority remained on their first-line regimen at 5 years of ART. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch. The estimates of this study provide an insight on the expected use of second-line regimens as the global pediatric HIV population matures and access to VL monitoring expands. A commitment to the availability of affordable pediatric drugs with high resistance barriers and low pill burden will be essential to ensure these needs are met.