Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa

Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa

Background. There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatmentexperienced children from resource...

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Veröffentlicht in:SAMJ: South African Medical Journal 2018-02, Vol.108 (2), p.105-110
Hauptverfasser: Pillay, V., Nuttall, J.
Format: Artikel
Sprache:eng
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Antiretroviral agents
Dosage and administration
Drug therapy
Health Care Sciences & Services
Health Policy & Services
Highly active antiretroviral therapy
Medical Ethics
Medicine, General & Internal
Medicine, Legal
Medicine, Research & Experimental
Patient outcomes
Pediatric HIV infections
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Nuttall, J.
description Background. There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatmentexperienced children from resource-constrained settings receiving these drugs as part of routine care. Objective. To describe the characteristics and early outcomes of treatment-experienced children (
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There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatmentexperienced children from resource-constrained settings receiving these drugs as part of routine care. Objective. To describe the characteristics and early outcomes of treatment-experienced children (&lt;20 years of age) in the Western Cape Province of South Africa treated with DRV/r-, RAL- or ETR-containing regimens. Methods. This was a retrospective review of treatment-experienced children receiving a DRV/r-, RAL- or ETR-containing regimen as recommended by a paediatric expert review committee, based on HIV drug resistance testing. Results. Thirty-five children of median age 8.8 years (interquartile range (IQR) 5.5 - 11) who had received ART for a median of 6.9 years (IQR 5 - 9.9) and started a DRV/r-, RAL- or ETR-containing regimen were included. Before starting such a regimen, the median CD4+ lymphocyte count and HIV-1 RNA level were 405.5 cells/μL (IQR 251.5 - 541) and 28 314 copies/mL (IQR 5 595.5 – 120 186.5) (log 4.5 (IQR 3.7 - 5)), respectively, in 24 subjects with available results. After a median of 2 years (IQR 1.3 - 4) on treatment, 29/30 (96.7%) and 23/30 (76.7%) subjects with available results had HIV-1 RNA levels of &lt;400 and &lt;50 copies/mL, respectively. Conclusions. This study found DRV/r-, RAL- and ETR-containing regimens to be effective in a group of treatment-experienced children and adolescents with multidrug-resistant HIV. Although the treatment regimens in this study were individualised based on HIV genotyping results, further research evaluating the safety and efficacy of standardised third-line treatment regimens in children of all ages is needed.</description><identifier>ISSN: 0256-9574</identifier><identifier>ISSN: 2078-5135</identifier><identifier>EISSN: 2078-5135</identifier><identifier>DOI: 10.7196/SAMJ.2018.v108i2.12573</identifier><language>eng</language><publisher>Health and Medical Publishing Group (HMPG)</publisher><subject>Antiretroviral agents ; Dosage and administration ; Drug therapy ; Health Care Sciences &amp; Services ; Health Policy &amp; Services ; Highly active antiretroviral therapy ; Medical Ethics ; Medicine, General &amp; Internal ; Medicine, Legal ; Medicine, Research &amp; Experimental ; Patient outcomes ; Pediatric HIV infections</subject><ispartof>SAMJ: South African Medical Journal, 2018-02, Vol.108 (2), p.105-110</ispartof><rights>COPYRIGHT 2018 Health &amp; Medical Publishing Group</rights><rights>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c426t-6915e8c24057e38d242af24172c3a444ca583164338eaea4a66b40374eb3e5993</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27901,27902,39219</link.rule.ids><linktorsrc>$$Uhttp://hdl.handle.net/10520/EJC-c66fb9d10$$EView_record_in_Sabinet_Online_Ltd.$$FView_record_in_$$GSabinet_Online_Ltd.</linktorsrc></links><search><creatorcontrib>Pillay, V.</creatorcontrib><creatorcontrib>Nuttall, J.</creatorcontrib><title>Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa</title><title>SAMJ: South African Medical Journal</title><addtitle>SAMJ, S. Afr. med. j</addtitle><description>Background. There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatmentexperienced children from resource-constrained settings receiving these drugs as part of routine care. Objective. To describe the characteristics and early outcomes of treatment-experienced children (&lt;20 years of age) in the Western Cape Province of South Africa treated with DRV/r-, RAL- or ETR-containing regimens. Methods. This was a retrospective review of treatment-experienced children receiving a DRV/r-, RAL- or ETR-containing regimen as recommended by a paediatric expert review committee, based on HIV drug resistance testing. Results. Thirty-five children of median age 8.8 years (interquartile range (IQR) 5.5 - 11) who had received ART for a median of 6.9 years (IQR 5 - 9.9) and started a DRV/r-, RAL- or ETR-containing regimen were included. Before starting such a regimen, the median CD4+ lymphocyte count and HIV-1 RNA level were 405.5 cells/μL (IQR 251.5 - 541) and 28 314 copies/mL (IQR 5 595.5 – 120 186.5) (log 4.5 (IQR 3.7 - 5)), respectively, in 24 subjects with available results. After a median of 2 years (IQR 1.3 - 4) on treatment, 29/30 (96.7%) and 23/30 (76.7%) subjects with available results had HIV-1 RNA levels of &lt;400 and &lt;50 copies/mL, respectively. Conclusions. This study found DRV/r-, RAL- and ETR-containing regimens to be effective in a group of treatment-experienced children and adolescents with multidrug-resistant HIV. Although the treatment regimens in this study were individualised based on HIV genotyping results, further research evaluating the safety and efficacy of standardised third-line treatment regimens in children of all ages is needed.</description><subject>Antiretroviral agents</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Health Care Sciences &amp; Services</subject><subject>Health Policy &amp; Services</subject><subject>Highly active antiretroviral therapy</subject><subject>Medical Ethics</subject><subject>Medicine, General &amp; Internal</subject><subject>Medicine, Legal</subject><subject>Medicine, Research &amp; Experimental</subject><subject>Patient outcomes</subject><subject>Pediatric HIV infections</subject><issn>0256-9574</issn><issn>2078-5135</issn><issn>2078-5135</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNpVUm2LEzEQXkTBevoXJCAIgruXZJPs7sdSzpfjRKGKH8M0O9vNsU1Kkt7R3-ifMtseaAkhM5nnmUyemaJ4y2jVsE5dr5ffbitOWVs9MNpaXjEum_pZseC0aUvJavm8WFAuVdnJRrwsXsV4T7MvO7Uo_qxGCGASBhuTNZGA6wlCmI7EH5LxO4zED8SMduoDulMYej9hNOhSJCkgJOzJo00j6SEcHDzYcB1s8ier_EgCTAm34eQRHwimk20dlsa7BNZZt82Jkw055HMIJpJGDLA_Eutmk_zGmEt0ZAV7JD9mkDM4F7bOVY5kOQRr4HXxYoAp4pun86r49enm5-pLeff989fV8q40gqtUqo5JbA0XVDZYtz0XHAYuWMNNDUIIA7KtmRJ13SIgCFBqI2jdCNzUKLuuviqqc95oLE5e3_tDcPlBvZ5V1rPKcztoFjlvxjPh3ZmwhQm1dYPPEpidjUYvJVdtwwST_9JeoPLqcWezUjjYfH9BeP8fYcSs8xj9dEjWu3gJVGegCT7GgIPeB7uDcNSM6nmG9DxDei5an2dIn2YoEz88_RQ2uV9JR8D9YZNpklN9c7vSRqlh0_WM1n8BbIPJRQ</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Pillay, V.</creator><creator>Nuttall, J.</creator><general>Health and Medical Publishing Group (HMPG)</general><general>Health &amp; Medical Publishing Group</general><general>Health and Medical Publishing Group</general><scope>AAYXX</scope><scope>CITATION</scope><scope>GPN</scope></search><sort><creationdate>20180201</creationdate><title>Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa</title><author>Pillay, V. ; Nuttall, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-6915e8c24057e38d242af24172c3a444ca583164338eaea4a66b40374eb3e5993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Antiretroviral agents</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Health Care Sciences &amp; Services</topic><topic>Health Policy &amp; Services</topic><topic>Highly active antiretroviral therapy</topic><topic>Medical Ethics</topic><topic>Medicine, General &amp; Internal</topic><topic>Medicine, Legal</topic><topic>Medicine, Research &amp; Experimental</topic><topic>Patient outcomes</topic><topic>Pediatric HIV infections</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pillay, V.</creatorcontrib><creatorcontrib>Nuttall, J.</creatorcontrib><collection>CrossRef</collection><collection>SciELO</collection><jtitle>SAMJ: South African Medical Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Pillay, V.</au><au>Nuttall, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa</atitle><jtitle>SAMJ: South African Medical Journal</jtitle><addtitle>SAMJ, S. Afr. med. j</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>108</volume><issue>2</issue><spage>105</spage><epage>110</epage><pages>105-110</pages><issn>0256-9574</issn><issn>2078-5135</issn><eissn>2078-5135</eissn><abstract>Background. There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatmentexperienced children from resource-constrained settings receiving these drugs as part of routine care. Objective. To describe the characteristics and early outcomes of treatment-experienced children (&lt;20 years of age) in the Western Cape Province of South Africa treated with DRV/r-, RAL- or ETR-containing regimens. Methods. This was a retrospective review of treatment-experienced children receiving a DRV/r-, RAL- or ETR-containing regimen as recommended by a paediatric expert review committee, based on HIV drug resistance testing. Results. Thirty-five children of median age 8.8 years (interquartile range (IQR) 5.5 - 11) who had received ART for a median of 6.9 years (IQR 5 - 9.9) and started a DRV/r-, RAL- or ETR-containing regimen were included. Before starting such a regimen, the median CD4+ lymphocyte count and HIV-1 RNA level were 405.5 cells/μL (IQR 251.5 - 541) and 28 314 copies/mL (IQR 5 595.5 – 120 186.5) (log 4.5 (IQR 3.7 - 5)), respectively, in 24 subjects with available results. After a median of 2 years (IQR 1.3 - 4) on treatment, 29/30 (96.7%) and 23/30 (76.7%) subjects with available results had HIV-1 RNA levels of &lt;400 and &lt;50 copies/mL, respectively. Conclusions. This study found DRV/r-, RAL- and ETR-containing regimens to be effective in a group of treatment-experienced children and adolescents with multidrug-resistant HIV. Although the treatment regimens in this study were individualised based on HIV genotyping results, further research evaluating the safety and efficacy of standardised third-line treatment regimens in children of all ages is needed.</abstract><pub>Health and Medical Publishing Group (HMPG)</pub><doi>10.7196/SAMJ.2018.v108i2.12573</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Antiretroviral agents
Dosage and administration
Drug therapy
Health Care Sciences & Services
Health Policy & Services
Highly active antiretroviral therapy
Medical Ethics
Medicine, General & Internal
Medicine, Legal
Medicine, Research & Experimental
Patient outcomes
Pediatric HIV infections
title Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa
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