Determinants of highly active antiretroviral therapy duration in HIV-1-infected children and adolescents in Madrid, Spain, from 1996 to 2012.
OBJECTIVE
To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents.


METHODS
Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain.


METHODS
Patients with a follow-up of ≥ 1 month spent on HAART, with available baseline CD4 count and HIV-viral load (VL) were included. Time spent on sequential HAART regimens was estimated and multivariable regression was used to identify predictors of time to first-line regimen discontinuation.


RESULTS
104 patients were followed for a median 8 years after starting HAART among 1996-2012; baseline %CD4 was 21.5 (12.3-34.0)and viral load was 5.1 (4.6-5.6) log10 copies/mL. Patients received a mean of 1.9 regimens. Median time on first-line HAART (n = 104) was 64.5 months; second HAART (n = 56) 69.8 months; and third HAART (n = 21) 66.5 months. Eleven (11%) patients were lost to follow-up while on first-line HAART and 54% discontinued (cumulative incidence of 16% and 38% by 1 and 3-year, respectively). The main predictor of first-line regimen discontinuation was suboptimal adherence to antiretrovirals (AHR: 2.60; 95% CI: 1.44-4.70).


CONCLUSIONS
Adherence to therapy was the main determinant of the duration of the first-line HAART regimen in children. It is important to identify patients at high risk for non-adherence, such as very young children and adolescents, in provide special care and support to those patients.
Instituto de Investigação do Medicamento (iMed. ULisboa), Faculty of Pharmacy, The University of Lisbon, Lisbon, Portugal.
Claudia
C
Palladino
Hospital General Universitario "Gregorio Marañón" and Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
Verónica
V
Briz
Unidad de Investigación, Fundación para la Investigación Biomédica, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
José María
JM
Bellón
Servicio Infecciosas Infantil, Hospital Universitario "La Paz", Madrid, Spain.
Francisco J
FJ
Climent
Hospital General Universitario "Gregorio Marañón" and Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
Santiago J
SJ
de Ory
Servicio de Pediatría, Hospital Universitario "Carlos III", Madrid, Spain.
María José
MJ
Mellado
Servicio de Pediatría, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
María Luisa
ML
Navarro
Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain.
José T
JT
Ramos
Instituto de Investigação do Medicamento (iMed. ULisboa), Faculty of Pharmacy, The University of Lisbon, Lisbon, Portugal; Center of Interdisciplinary Investigation Egas Moniz (CiiEM), Institute of Health Sciences Egas Moniz, Caparica, Portugal.
Nuno
N
Taveira
Servicio Infecciosas Infantil, Hospital Universitario "La Paz", Madrid, Spain.
María Isabel
MI
de José
Hospital General Universitario "Gregorio Marañón" and Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
María Ángeles
MÁ
Muñoz-Fernández
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008297:Male; D010349:Patient Compliance; D012044:Regression Analysis; D012307:Risk Factors; D013030:Spain; D019562:Viral Load / Q000187:drug effects