Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy.
OBJECTIVE
To assess the incidence and predictors of postsuppression virologic rebound (VR) among adolescents on stable combination antiretroviral therapy in Asia.


METHODS
Perinatally HIV-infected Asian adolescents (10-19 years) with documented virologic suppression (two consecutive viral loads [VLs] <400 copies/mL ≥6 months apart) were included. Baseline was the date of the first VL <400 copies/mL at age ≥10 years or the 10th birthday for those with prior suppression. Cox proportional hazards models were used to identify predictors of postsuppression VR (VL >1,000 copies/mL).


RESULTS
Of 1,379 eligible adolescents, 47% were males. At baseline, 22% were receiving protease inhibitor-containing regimens; median CD4 cell count (interquartile range [IQR]) was 685 (448-937) cells/mm3; 2% had preadolescent virologic failure (VF) before subsequent suppression. During adolescence, 180 individuals (13%) experienced postsuppression VR at a rate of 3.4 (95% confidence interval: 2.9-3.9) per 100 person-years, which was consistent over time. Median time to VR during adolescence (IQR) was 3.3 (2.1-4.8) years. Wasting (weight-for-age z-score <-2.5), being raised by grandparents, receiving second-line protease inhibitor-based regimens, starting combination antiretroviral therapy after 2005, and having preadolescent VF were independent predictors of adolescent VR. At VR, median age, CD4 cell count, and VL (IQR) were 14.8 (13.2-16.4) years, 507 (325-723) cells/mm3, and 4.1 (3.5-4.7) log10copies/mL, respectively.


CONCLUSIONS
A modest and consistent incidence of postsuppression VR was documented during adolescence in our cohort. Having poor weight, receiving second-line regimens, and prior VF were associated with an increased VR rate. Adolescents at higher risk of VR may benefit from more intensive VL monitoring to enhance adherence management.
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address: tavitiya.s@cmu.ac.th.
Tavitiya
T
Sudjaritruk
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
Linda
L
Aurpibul
National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia.
Penh Sun
PS
Ly
Infectious Disease Department, Children's Hospital 1, Ho Chi Minh City, Vietnam.
Thoa Phan Kim
TPK
Le
HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Torsak
T
Bunupuradah
Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
Rawiwan
R
Hansudewechakul
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Pagakrong
P
Lumbiganon
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Kulkanya
K
Chokephaibulkit
Department of Pediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia.
Nik Khairulddin
NK
Nik Yusoff
Infectious Disease Department, National Hospital of Pediatrics, Hanoi, Vietnam.
Lam Van
LV
Nguyen
Department of Pediatrics, Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Kamarul Azahar
KA
Mohd Razali
Department of Pediatrics, Hospital Likas, Kota Kinabalu, Malaysia.
Moy Siew
MS
Fong
Department of Pediatrics, Penang Hospital, Georgetown, Penang, Malaysia.
Revathy A
RA
Nallusamy
Department of Child Health, Cipto Mangunkusumo - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Nia
N
Kurniati
Infectious Disease Department, Children's Hospital 2, Ho Chi Minh City, Vietnam.
Viet Chau
VC
Do
Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, Australia.
David C
DC
Boettiger
TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand.
Annette H
AH
Sohn
Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, Australia.
Azar
A
Kariminia
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001210:Asia, Southeastern; D002648:Child; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D012008:Recurrence; D019562:Viral Load
Adolescents; Asia; Children; Highly active antiretroviral therapy; Pediatric; Perinatal HIV infection; Treatment failure; Virologic failure