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Antiretroviral treatment outcome following genotyping in Thai children who failed dual nucleoside reverse transcriptase inhibitors.
Int J Infect Dis. 2010 Apr; 14(4):e311-6.IJ

Abstract

OBJECTIVE

To evaluate outcomes in dual nucleoside reverse transcriptase inhibitor (NRTI) pretreated children after genotyping (GT).

METHODS

We assessed CD4 and viral load (VL) in children three years after baseline GT at the time of dual NRTI failure. Baseline high grade resistance (HR) was defined as >or=4 nucleoside analogue mutations (NAMs)+/-Q151M or 69 insertion complex, and low grade resistance (LR) was defined as <4 NAMs. Genotypic susceptibility scores (GSS) were determined. The current selection of antiretrovirals (ARV) was based on physician judgment and ARV availability.

RESULTS

Seventy-two children were enrolled, with a mean age of 9.3 years; 61% were female. Baseline median CD4 was 18%, VL was 1.7 log(10) with HR 37.5%, LR 56.9% and no mutation (NR, no resistance) 5.6%. Sixty-five (90.3%) switched ARV: 46.2% non-nucleoside reverse transcriptase inhibitor (NNRTI), 30.8% protease inhibitor (PI), and 23.1% PI+NNRTI based highly active antiretroviral therapy (HAART). The choice of regimen did not differ based on baseline HR, LR, and NR. The median duration from dual NRTI therapy to HAART was 5.4 years (interquartile range (IQR) 4.0-6.9 years) and the mean (SD) duration of current HAART regimen was 1.51 (1.78) years; both were similar between ARV groups. Five children continued dual NRTI, two interrupted therapy. The GSS score was significantly higher in the PI group (3.1) vs. PI+NNRTI (2.5) vs. NNRTI (2.6) groups. Sixty-three percent of the HR group used PI or PI+NNRTI-based HAART compared to 41% of the LR group, p=not significant. At follow-up, median CD4 changes from baseline were +5% and VL -2.2 log(10) (p<0.001). VL <1.7 log(10) was seen in 59.3% of HR, 58.5% of LR, and 50.0% of NR groups (no significant difference). More children on PI (75%) and PI+NNRTI (80%) based HAART had VL <50 compared to NNRTI-based HAART (50%), p=0.003.

CONCLUSION

PI-based regimens showed a higher rate of undetectable VL compared with NNRTI-based regimens. Having GT may not affect second-line treatment choices in developing countries, most likely due to late VL failure and limited availability of PIs.

Authors+Show Affiliations

The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand. torsak.b@hivnat.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19699673

Citation

Bunupuradah, Torsak, et al. "Antiretroviral Treatment Outcome Following Genotyping in Thai Children Who Failed Dual Nucleoside Reverse Transcriptase Inhibitors." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 14, no. 4, 2010, pp. e311-6.
Bunupuradah T, Suntarattiwong P, Li A, et al. Antiretroviral treatment outcome following genotyping in Thai children who failed dual nucleoside reverse transcriptase inhibitors. Int J Infect Dis. 2010;14(4):e311-6.
Bunupuradah, T., Suntarattiwong, P., Li, A., Sirivichayakul, S., Pancharoen, C., Boonrak, P., Puthanakit, T., Kerr, S. J., Ruxrungtham, K., Chotpitayasunondh, T., Hirschel, B., & Ananworanich, J. (2010). Antiretroviral treatment outcome following genotyping in Thai children who failed dual nucleoside reverse transcriptase inhibitors. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 14(4), e311-6. https://doi.org/10.1016/j.ijid.2009.05.017
Bunupuradah T, et al. Antiretroviral Treatment Outcome Following Genotyping in Thai Children Who Failed Dual Nucleoside Reverse Transcriptase Inhibitors. Int J Infect Dis. 2010;14(4):e311-6. PubMed PMID: 19699673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiretroviral treatment outcome following genotyping in Thai children who failed dual nucleoside reverse transcriptase inhibitors. AU - Bunupuradah,Torsak, AU - Suntarattiwong,Piyarat, AU - Li,Andrea, AU - Sirivichayakul,Sunee, AU - Pancharoen,Chitsanu, AU - Boonrak,Pitch, AU - Puthanakit,Thanyawee, AU - Kerr,Stephen J, AU - Ruxrungtham,Kiat, AU - Chotpitayasunondh,Tawee, AU - Hirschel,Bernard, AU - Ananworanich,Jintanat, AU - ,, Y1 - 2009/08/21/ PY - 2008/12/04/received PY - 2009/05/21/revised PY - 2009/05/25/accepted PY - 2009/8/25/entrez PY - 2009/8/25/pubmed PY - 2010/6/29/medline SP - e311 EP - 6 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 14 IS - 4 N2 - OBJECTIVE: To evaluate outcomes in dual nucleoside reverse transcriptase inhibitor (NRTI) pretreated children after genotyping (GT). METHODS: We assessed CD4 and viral load (VL) in children three years after baseline GT at the time of dual NRTI failure. Baseline high grade resistance (HR) was defined as >or=4 nucleoside analogue mutations (NAMs)+/-Q151M or 69 insertion complex, and low grade resistance (LR) was defined as <4 NAMs. Genotypic susceptibility scores (GSS) were determined. The current selection of antiretrovirals (ARV) was based on physician judgment and ARV availability. RESULTS: Seventy-two children were enrolled, with a mean age of 9.3 years; 61% were female. Baseline median CD4 was 18%, VL was 1.7 log(10) with HR 37.5%, LR 56.9% and no mutation (NR, no resistance) 5.6%. Sixty-five (90.3%) switched ARV: 46.2% non-nucleoside reverse transcriptase inhibitor (NNRTI), 30.8% protease inhibitor (PI), and 23.1% PI+NNRTI based highly active antiretroviral therapy (HAART). The choice of regimen did not differ based on baseline HR, LR, and NR. The median duration from dual NRTI therapy to HAART was 5.4 years (interquartile range (IQR) 4.0-6.9 years) and the mean (SD) duration of current HAART regimen was 1.51 (1.78) years; both were similar between ARV groups. Five children continued dual NRTI, two interrupted therapy. The GSS score was significantly higher in the PI group (3.1) vs. PI+NNRTI (2.5) vs. NNRTI (2.6) groups. Sixty-three percent of the HR group used PI or PI+NNRTI-based HAART compared to 41% of the LR group, p=not significant. At follow-up, median CD4 changes from baseline were +5% and VL -2.2 log(10) (p<0.001). VL <1.7 log(10) was seen in 59.3% of HR, 58.5% of LR, and 50.0% of NR groups (no significant difference). More children on PI (75%) and PI+NNRTI (80%) based HAART had VL <50 compared to NNRTI-based HAART (50%), p=0.003. CONCLUSION: PI-based regimens showed a higher rate of undetectable VL compared with NNRTI-based regimens. Having GT may not affect second-line treatment choices in developing countries, most likely due to late VL failure and limited availability of PIs. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/19699673/Antiretroviral_treatment_outcome_following_genotyping_in_Thai_children_who_failed_dual_nucleoside_reverse_transcriptase_inhibitors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(09)00232-X DB - PRIME DP - Unbound Medicine ER -