title: Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance.
abstract: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.
  
  
  
  Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.
  
  
  
  60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.
  
  
  
  No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.
authors.affiliation: Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.|Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ragna S
authors.initials: RS
authors.lastname: Boerma
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda.
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.affiliation: Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.|Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.|Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: T Sonia
authors.initials: TS
authors.lastname: Boender
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kaudha
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kayiwa
authors.affiliation: Department of Pediatrics and Child Health, Makerere College of Health Sciences, Kampala, Uganda.
authors.forename: Victor
authors.initials: V
authors.lastname: Musiime
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mukuye
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Mary
authors.initials: M
authors.lastname: Kiconco
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Immaculate
authors.initials: I
authors.lastname: Nankya
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Lilian
authors.initials: L
authors.lastname: Nakatudde
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Mugyenyi
authors.affiliation: Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Boele van Hensbroek
authors.affiliation: Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Rinke de Wit
authors.affiliation: Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.|Department of Infectious Diseases, Division of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Kim C E
authors.initials: KCE
authors.lastname: Sigaloff
authors.affiliation: Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.|Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Job C J
authors.initials: JCJ
authors.lastname: Calis
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D009154:Mutation; D015995:Prevalence; D017211:Treatment Failure; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors
keywords: HIV drug resistance; HIV-1; antiretroviral treatment; genotypic resistance testing.; second-line