Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe. HIV Medicine
Judd et al. on behalf of COHERE in EuroCoord aimed to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection.
A total of 5’972 participants starting antiretroviral therapy (ART) from 1998, aged 500 HIV-1 RNA copies/mL despite ≥4 months of use.
The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall (17 vs. 8 weeks) and highest in perinatally infected participants aged 10–14 years (49 weeks). The cumulative proportion with TCVF 5 years after starting ART was 9.6% in participants with perinatally acquired infection and 4.7% in participants with heterosexually acquired infection. Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10–14 years, African origin, pre-ART AIDS, NNRTI based initial regimens, higher pre-ART viral load and lower pre-ART CD4.
In conclusion, for participants with perinatal HIV infection, these findings indicate the need to diagnose and start ART earlier in childhood, and adopt a strategic approach in ART selection to prevent the emergence of resistance. These measures may help children and adolescents achieve and sustain virological suppression as they approach adulthood.