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WEDNESDAY, April 20 (HealthDay News) -- The rate of triple-class virological failure to three or more antiretroviral therapy (ART) drugs in children infected perinatally with HIV is low, but higher than the rate in adults, according to a study published online April 20 in The Lancet.
Hannah Castro, and colleagues from the Pursuing Later Treatment Options II project, investigated the rate and predictors of triple-class virological failure to three or more ART drugs in 1,007 HIV-infected children who were younger than 16 years of age within the Collaboration of Observational HIV Epidemiological Research Europe. Participants started ART with three or more drugs between 1998 and 2008, and were followed up for an average of 4.2 years.
The investigators found that 237 children (24 percent) were triple-class exposed, and 105 (10 percent) experienced triple-class virological failure, 29 of whom had never had a viral-load measurement lower than 500 copies per ml. The incidence of triple-class virological failure increased with time after ART initiation, reaching 12 percent by five years after initiation. ART initiation at older age was significantly correlated with elevated risk of viral failure. The rate of failure was higher in 686 children starting ART with nucleotide reverse transcriptase inhibitors (NRTIs), and either a non-NRTI or ritonavir-boosted protease inhibitor, than in adults with heterosexually transmitted HIV (hazard ratio, 2.2).
"Early identification of children not responding to ART, adherence support, particularly for children and adolescents aged 13 years or older starting ART, and ART simplification strategies are all needed to attain and sustain virological suppression," the authors write.
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