title: Short Communication: Impact of Viral Load Use on Treatment Switch in Perinatally HIV-Infected Children in Asia.
abstract: We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.
authors.affiliation: 1 Pediatric Institute , Hospital Kuala Lumpur, Kuala Lumpur, Malaysia .
authors.forename: Thahira
authors.initials: T
authors.lastname: Jamal Mohamed
authors.affiliation: 2 HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
authors.forename: Sirinya
authors.initials: S
authors.lastname: Teeraananchai
authors.affiliation: 2 HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
authors.forename: Stephen
authors.initials: S
authors.lastname: Kerr
authors.affiliation: 3 Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand .
authors.forename: Wanatpreeya
authors.initials: W
authors.lastname: Phongsamart
authors.affiliation: 4 Hospital Raja Perempuan Zainab II , Kelantan, Malaysia .
authors.forename: Nik Khairulddin
authors.initials: NK
authors.lastname: Nik Yusoff
authors.affiliation: 5 Chiangrai Prachanukroh Hospital , Chiang Rai, Thailand .
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.affiliation: 6 National Centre for HIV/AIDS , Dermatology and STDs, Phnom Penh, Cambodia .
authors.forename: Penh Sun
authors.initials: PS
authors.lastname: Ly
authors.affiliation: 7 National Hospital of Pediatrics , Hanoi, Vietnam .
authors.forename: Lam Van
authors.initials: LV
authors.lastname: Nguyen
authors.affiliation: 8 Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University , Chiang Mai, Thailand .
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.affiliation: 9 Department of Pediatrics, Khon Kaen University , Khon Kaen, Thailand .
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.affiliation: 10 Children's Hospital 2 , Ho Chi Minh City, Vietnam .
authors.forename: Viet Chau
authors.initials: VC
authors.lastname: Do
authors.affiliation: 11 Cipto Mangunkusumo General Hospital , Jakarta, Indonesia .
authors.forename: Nia
authors.initials: N
authors.lastname: Kurniati
authors.affiliation: 12 YRGCARE Medical Centre , CART CRS, Chennai, India .
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: 13 Sanglah Hospital, Udayana University , Bali, Indonesia .
authors.forename: Dewi Kumara
authors.initials: DK
authors.lastname: Wati
authors.affiliation: 14 Hospital Likas , Kota Kinabalu, Malaysia .
authors.forename: Moy Siew
authors.initials: MS
authors.lastname: Fong
authors.affiliation: 15 Penang Hospital , Penang, Malaysia .
authors.forename: Revathy
authors.initials: R
authors.lastname: Nallusamy
authors.affiliation: 16 The Kirby Institute , UNSW Australia, Sydney, Australia .
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.affiliation: 17 TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok, Thailand .
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001208:Asia; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods*; D057915:Drug Substitution; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; antiretroviral therapy; molecular virology