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- Publisher Website: 10.1097/INF.0000000000000544
- Scopus: eid_2-s2.0-85005893744
- PMID: 25741970
- WOS: WOS:000349908800014
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Article: Virologic Failure Among Children Taking Lopinavir/Ritonavir-containing First-line Antiretroviral Therapy in South Africa
Title | Virologic Failure Among Children Taking Lopinavir/Ritonavir-containing First-line Antiretroviral Therapy in South Africa |
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Authors | |
Keywords | Children HIV Lopinavir/ritonavir Virologic failure |
Issue Date | 2015 |
Citation | Pediatric Infectious Disease Journal , v. 34 n. 2, p. 175-179 How to Cite? |
Abstract | Objective: To report the outcomes, clinical management decisions and results of resistance testing among a group of children who developed virologic failure on first-line lopinavir/ritonavir (LPV/r)-based therapy from a large cohort of antiretroviral therapy-treated children in Soweto. Design: Historical cohort study. Methods: Children with virologic failure were identified from a group of 1692 children <3 years who had initiated first-line LPV/r-containing therapy since 2000 up to the end November 2011. Genotyping was conducted in some children, and outcomes, management decisions and resistance results were described. Results: A total of 152 children with virologic failure on first-line LPV/r-containing antiretroviral therapy were included. Resistance testing was performed in 75/152 (49%), and apart from a younger age (11.1 vs. 15.1 months, P = 0.04), the children with versus those without resistance testing were similar for baseline characteristics (weight, CD4, viral load and time to failure). Genotyping revealed that 8/75 (10.7%) had significant LPV/r-associated resistance mutations, including 2 with intermediate darunavir resistance. Among 63/75 (84%) children remaining on LPV/r-based therapy, 32/63 (51%) achieved virologic suppression, and 2 of these children with significant LPV mutations. In accordance with the local guidelines at the time, 12/152 (8%) children were switched to non-nucleoside reverse-transcriptase inhibitors-based therapy. Of these, 4/12 (33%) resuppressed, and the rest did not achieve virologic suppression including the 2 with lopinavir mutations. Conclusions: Virologic failure of LPV/r-containing first-line regimens is associated with accumulation of LPV/r mutations in children. The implications are unclear, and surveillance at selected sites is warranted for long-term virologic outcomes and development of resistance. Copyright © 2014 by Wolters Kluwer Health, Inc. All rights reserved. |
Persistent Identifier | http://hdl.handle.net/10722/209416 |
ISSN | 2023 Impact Factor: 2.9 2023 SCImago Journal Rankings: 0.888 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Meyers, T | en_US |
dc.contributor.author | Sawry, S | en_US |
dc.contributor.author | Wong, YT | en_US |
dc.contributor.author | Moultrie, H | en_US |
dc.contributor.author | Pinillos, F | en_US |
dc.contributor.author | Fairlie, L | en_US |
dc.contributor.author | Zyl, GV | en_US |
dc.date.accessioned | 2015-04-17T05:15:47Z | - |
dc.date.available | 2015-04-17T05:15:47Z | - |
dc.date.issued | 2015 | en_US |
dc.identifier.citation | Pediatric Infectious Disease Journal , v. 34 n. 2, p. 175-179 | en_US |
dc.identifier.issn | 0891-3668 | - |
dc.identifier.uri | http://hdl.handle.net/10722/209416 | - |
dc.description.abstract | Objective: To report the outcomes, clinical management decisions and results of resistance testing among a group of children who developed virologic failure on first-line lopinavir/ritonavir (LPV/r)-based therapy from a large cohort of antiretroviral therapy-treated children in Soweto. Design: Historical cohort study. Methods: Children with virologic failure were identified from a group of 1692 children <3 years who had initiated first-line LPV/r-containing therapy since 2000 up to the end November 2011. Genotyping was conducted in some children, and outcomes, management decisions and resistance results were described. Results: A total of 152 children with virologic failure on first-line LPV/r-containing antiretroviral therapy were included. Resistance testing was performed in 75/152 (49%), and apart from a younger age (11.1 vs. 15.1 months, P = 0.04), the children with versus those without resistance testing were similar for baseline characteristics (weight, CD4, viral load and time to failure). Genotyping revealed that 8/75 (10.7%) had significant LPV/r-associated resistance mutations, including 2 with intermediate darunavir resistance. Among 63/75 (84%) children remaining on LPV/r-based therapy, 32/63 (51%) achieved virologic suppression, and 2 of these children with significant LPV mutations. In accordance with the local guidelines at the time, 12/152 (8%) children were switched to non-nucleoside reverse-transcriptase inhibitors-based therapy. Of these, 4/12 (33%) resuppressed, and the rest did not achieve virologic suppression including the 2 with lopinavir mutations. Conclusions: Virologic failure of LPV/r-containing first-line regimens is associated with accumulation of LPV/r mutations in children. The implications are unclear, and surveillance at selected sites is warranted for long-term virologic outcomes and development of resistance. Copyright © 2014 by Wolters Kluwer Health, Inc. All rights reserved. | - |
dc.language | eng | en_US |
dc.relation.ispartof | Pediatric Infectious Disease Journal | en_US |
dc.subject | Children | - |
dc.subject | HIV | - |
dc.subject | Lopinavir/ritonavir | - |
dc.subject | Virologic failure | - |
dc.title | Virologic Failure Among Children Taking Lopinavir/Ritonavir-containing First-line Antiretroviral Therapy in South Africa | en_US |
dc.type | Article | en_US |
dc.identifier.email | Wong, YT: wongytj@hku.hk | en_US |
dc.identifier.doi | 10.1097/INF.0000000000000544 | en_US |
dc.identifier.pmid | 25741970 | - |
dc.identifier.pmcid | PMC4352713 | - |
dc.identifier.scopus | eid_2-s2.0-85005893744 | - |
dc.identifier.hkuros | 242868 | en_US |
dc.identifier.volume | 34 | en_US |
dc.identifier.spage | 175 | en_US |
dc.identifier.epage | 179 | en_US |
dc.identifier.isi | WOS:000349908800014 | - |
dc.identifier.issnl | 0891-3668 | - |