Initial response to protease-inhibitor-based antiretroviral therapy among children less than 2 years of age in South Africa: effect of cotreatment for tuberculosis.
BACKGROUND
South African guidelines recommend protease-inhibitor-based antiretroviral therapy (ART) with lopinavir-ritonavir for human immunodeficiency virus (HIV)-infected children <36 months of age. We investigated factors associated with viral suppression and mortality among young children initiating ART.


METHODS
Treatment-naive, ART-eligible, HIV-infected children (aged 6-104 weeks) were enrolled in an ART strategies trial in South Africa and initiated protease-inhibitor-based ART. Mortality and the probability of viral suppression (defined as HIV RNA load of <400 copies/mL) by 39 weeks after ART initiation were investigated.


RESULTS
Of 254 children who initiated ART, 99 (39%) were cotreated for tuberculosis during follow-up. The mortality rate was 14%. Factors predicting mortality were lower pre-ART weight-for-age z score and higher HIV RNA load. By 39 weeks, 84% of surviving children achieved viral suppression. Children who were not cotreated for tuberculosis were more likely to achieve viral suppression (94.8%) than were children who were receiving cotreatment at ART initiation (74.2%) or who started tuberculosis cotreatment after ART initiation (51.6%; P < .001). Other factors predicting lower probability of viral suppression were lower pre-ART weight- and length-for-age z score, higher HIV RNA load, and World Health Organization disease stage.


CONCLUSIONS
High rates of viral suppression can be achieved among infants and young children who initiate protease-inhibitor-based ART. Cotreatment for tuberculosis reduced viral suppression. How best to treat HIV-infected children who require tuberculosis treatment warrants urgent investigation.
Reitz
Cordula
C
Gertrude H. Sergievsky Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York 10032, USA.
Coovadia
Ashraf
A
Ko
Stephen
S
Meyers
Tammy
T
Strehlau
Renate
R
Sherman
Gayle
G
Kuhn
Louise
L
Abrams
Elaine J
EJ
D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005000:Ethionamide / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D061466:Lopinavir; D008297:Male; D011744:Pyrimidinones / Q000008:administration & dosage / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D019438:Ritonavir / Q000008:administration & dosage / Q000627:therapeutic use*; D013019:South Africa; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy*; D019562:Viral Load / Q000187:drug effects
D000995:Antitubercular Agents; D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D012367:RNA, Viral; D061466:Lopinavir; D019438:Ritonavir; D005000:Ethionamide; D007538:Isoniazid; D012293:Rifampin