title: Risk of first-line antiretroviral therapy failure in HIV-infected Thai children and adolescents.
abstract: BACKGROUND
  Adolescence may affect adherence and response to highly active antiretroviral therapy (HAART). Limited data are available regarding the long-term treatment outcomes of perinatal HIV-infected adolescents.
  
  
  METHODS
  Data from perinatally acquired HIV-infected Thai children who started first-line nonnucleoside analog-based HAART before 18 years of age and treated for ≥24 weeks were analyzed. Children were categorized by age at HAART initiation; age<3 years, 3-9 years, early adolescence (10-13 years) and middle adolescence (14-16 years). CD4 and HIV-RNA were monitored every 6-12 months. Virologic failure (VF) was defined as HIV-RNA≥1000 copies/mL after ≥24 weeks of HAART.
  
  
  RESULTS
  Of 840 children, 68% were in pre-adolescence. Median baseline CD4% was 7.9%. Use of nevirapine versus efavirenz was 77:23%. Median duration of nonnucleoside reverse transcriptase inhibitor-based HAART was 5.6 years. No differences between groups were observed for rate of HIV-RNA<50 copies/mL (68%, P=0.18) and rate of VF (28%, P=0.82), median time to VF (22 months, P=0.13). Incidence of VF per 100 child-year in children age<3 years, 3-9 years, early adolescence and middle adolescence were 7.9, 4.7, 7.4 and 10.8, respectively (P=0.012). Median adherence by pill count was 97.3% (P=0.23). By multivariate analysis, predictors for VF were age at HAART initiation of <3 years (HR: 1.73, 95% CI: 1.18-2.55), age 10-16 years (HR: 1.47, 95% CI: 1.09-1.97), and nevirapine use (HR: 1.63, 95% CI: 1.14-2.32).
  
  
  CONCLUSIONS
  VF rates were observed in one-third of long-term treated Thai children on first-line HAART. Age 3-9 years at HAART initiation was associated with less VF compared with those younger or older, whereas children who used nevirapine had higher VF.
authors.affiliation: From the *HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand; †Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; ‡ChiangraiPrachanukroh Hospital, Chiangrai, Thailand; §Sanpatong Hospital, Chiang Mai, Thailand; ¶Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand; ‖SEARCH, the Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Sirintip
authors.initials: S
authors.lastname: Sricharoenchai
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Virat
authors.initials: V
authors.lastname: Klinbuayaem
authors.forename: Sirinya
authors.initials: S
authors.lastname: Teeraananchai
authors.forename: Orasri
authors.initials: O
authors.lastname: Wittawatmongkol
authors.forename: Noppadon
authors.initials: N
authors.lastname: Akarathum
authors.forename: Wisit
authors.initials: W
authors.lastname: Prasithsirikul
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000293:Adolescent; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006801:Humans; D007223:Infant; D055118:Medication Adherence; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D013785:Thailand / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load