Lars Jørgen Østergaard

Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Sophie Desmonde
  • ,
  • François T Eboua
  • ,
  • Karen Malateste
  • ,
  • Fatoumata Dicko
  • ,
  • Didier K Ekouévi
  • ,
  • Sylvie Ngbeché, Denmark
  • Fla Koueta
  • ,
  • Haby Signate Sy
  • ,
  • Lorna Renner
  • ,
  • Siriatou A Koumakpai, Denmark
  • Valeriane Leroy
  • ,
  • IeDEA Pediatric West African Working Group (Lars Østergaard, Alex Lund Laursen, Christian Wejse, Christian Erikstrup; members)

BACKGROUND: We described reasons for switching to second-line antiretroviral treatment (ART) and time to switch in HIV-infected children failing first-line ART in West Africa.

METHODS: We included all children aged 15 years or less, starting ART (at least three drugs) in the paediatric IeDEA clinical centres in five West-African countries. We estimated the incidence of switch (at least one a drug class change) within 24 months of ART and associated factors were identified in a multinomial logistic regression. Among children with clinical-immunological failure, we estimated the 24-month probability of switching to a second-line and associated factors, using competing risks. Children who switched to second-line ART following the withdrawal of nelfinavir in 2007 were excluded.

RESULTS: Overall, 2820 children initiated ART at a median age of 5 years; 144 (5%) were on nelfinavir. At 24-month post-ART initiation, 188 (7%) had switched to second-line. The most frequent reasons were drug stock outs (20%), toxicity (18%), treatment failure (16%) and poor adherence (8%). Over the 24-month follow-up period, 322 (12%) children failed first-line ART after a median time of 7 months. Of these children, 21 (7%) switched to second-line after a median time of 21 weeks in failure. This was associated with older age [subdistribution hazard ratio (sHR) 1.21, 95% confidence interval (95% CI) 1.10-1.33] and longer time on ART (sHR 1.16, 95% CI 1.07-1.25).

CONCLUSION: Switches for clinical failure were rare and switches after an immunological failure were insufficient. These gaps reveal that it is crucial to advocate for both sustainable access to first-line and alternative regimens to provide adequate roll-out of paediatric ART programmes.

Original languageEnglish
Pages (from-to)1527-36
Number of pages10
Publication statusPublished - 31 Jul 2015

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