title: Long-term Virologic Suppression Despite Presence of Resistance-associated Mutations Among Perinatally HIV-infected Youth.
abstract: BACKGROUND
  There is limited information on long-term consequences of continuing combination antiretroviral therapy (cART) consisting of <3 active drugs in treatment-experienced youth with perinatal HIV (PHIV). This study describes the clinical outcomes of PHIV youth who maintained virologic suppression (VS) for ≥1 year despite receiving cART with <3 active agents.
  
  
  METHODS
  A retrospective cohort study was conducted to quantify the duration of VS (viral load < 400 copies/mL), and using Cox proportional hazards regression, we identify factors associated with the primary outcome of virologic breakthrough (VB).
  
  
  RESULTS
  Thirty-seven patients were included. The median age, baseline CD4 count and HIV RNA viral load were 14 years, 477 cells/mm and 2920 copies/mL, respectively. All patients harbored reverse transcriptase, and 57% harbored protease mutations. The median duration of VS was 37 months (interquartile range: 22-66). Fifteen patients (41%) had VB. The median change in CD4 count during VS was +82 cells/mm at 12 months. The risk of VB was lower in those who gained ≥50 cells/mm by 12 months (unadjusted hazards ratio: 0.271; 95% confidence interval: 0.0825-0.893; P, 0.032); however, this was not significant in the adjusted model.
  
  
  CONCLUSIONS
  VS was maintained for a median of 3 years without decline in CD4 count. Independent risk factors for VB were not identified; however, there was a trend toward higher risk of VB in those without CD4 gain of ≥50 cells/mm by 12 months. Suppressive cART containing <3 active agents could be an option in difficult to manage PHIV youth with close monitoring.
authors.affiliation: From the *Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland; †Division of General Pediatrics, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; ‡University of Florida College of Pharmacy, Gainesville, Florida; §Division of Pediatric Infectious Diseases, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Tiffeny T
authors.initials: TT
authors.lastname: Smith
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Hsu
authors.forename: Nancy
authors.initials: N
authors.lastname: Hutton
authors.forename: Faith
authors.initials: F
authors.lastname: Womble
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D009154:Mutation / Q000235:genetics; D012189:Retrospective Studies; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents