Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia

被引：0

作者：

Bartlett, Adam W. ^{[1
,27
]}

Lumbiganon, Pagakrong ^{[2
,23
]}

Kurniati, Nia ^{[3
]}

Sudjaritruk, Tavitiya ^{[4
,5
]}

Mohamed, Thahira J. ^{[6
,16
]}

Hansudewechakul, Rawiwan ^{[7
]}

Ly, Penh S. ^{[8
]}

Truong, Khanh H. ^{[9
]}

Puthanakit, Thanyawee ^{[10
,11
]}

Nguyen, Lam, V ^{[12
]}

Chokephaibulkit, Kulkanya ^{[13
]}

Do, Viet C. ^{[14
]}

Kumarasamy, Nagalingeswaran ^{[15
,22
]}

Yusoff, Nik Khairulddin Nik ^{[16
]}

Fong, Moy S. ^{[17
]}

Watu, Dewi K. ^{[18
]}

Nallusamy, Revathy ^{[19
]}

Sohn, Annette H. ^{[20
]}

Law, Matthew G. ^{[1
,27
]}

Ly, P. S. ^{[8
]}

Khol, V ^{[8
]}

Tucker, J. ^{[21
]}

Kumarasamy, N. ^{[22
]}

Chandrasekaran, E.

Wati, D. K. ^{[18
]}

Vedaswari, D. ^{[18
]}

Ramajaya, I. B. ^{[18
]}

Kurniati, N. ^{[3
]}

Muktiarti, D. ^{[3
]}

Fong, S. M. ^{[17
]}

Lim, M. ^{[17
]}

Daut, F. ^{[17
]}

Yusoff, N. K. Nik ^{[16
]}

Mohamad, P. ^{[16
]}

Mohamed, T. J. ^{[6
,16
]}

Drawis, M. R. ^{[6
]}

Nallusamy, R. ^{[19
]}

Chan, K. C. ^{[19
]}

Sudjaritruk, T. ^{[4
,5
]}

Sirisanthana, V ^{[4
,5
]}

Aurpibul, L. ^{[4
,5
]}

Hansudewechakul, R. ^{[7
]}

Ounchanum, P. ^{[7
]}

Denjanta, S. ^{[7
]}

Kongphonoi, A. ^{[7
]}

Lumbiganon, P. ^{[23
]}

Kosalaraksa, P. ^{[23
]}

Tharnprisan, P. ^{[23
]}

Udomphanit, T. ^{[23
]}

Jourdain, G. ^{[24
,25
]}

机构：

[1] Univ New South Wales Sydney, Kirby Inst, Level 6,Wallace Wurth Bldg, Sydney, NSW 2052, Australia

[2] Khon Kaen Univ, Fac Med, Dept Pediat, Khon Kaen, Thailand

[3] Univ Indonesia, Fac Med, Cipto Mangunkusumo, Jakarta, Indonesia

[4] Chiang Mai Univ, Fac Med, Dept Pediat, Chiang Mai, Thailand

[5] Chiang Mai Univ, Res Inst Hlth Sci, Chiang Mai, Thailand

[6] Hosp Kuala Lumpur, Pediat Inst, Kuala Lumpur, Malaysia

[7] Chiangrai Prachanukroh Hosp, Chiang Rai, Thailand

[8] Natl Ctr HIV AIDS Dermatol & STDs, Phnom Penh, Cambodia

[9] Childrens Hosp 1, Ho Chi Minh City, Vietnam

[10] Chulalongkorn Univ, Fac Med, Dept Pediat, Bangkok, Thailand

[11] Chulalongkorn Univ, Res Unit Pediat & Infect Dis, Bangkok, Thailand

[12] Natl Hosp Pediat, Hanoi, Vietnam

[13] Mahidol Univ, Fac Med, Dept Pediat, Siriraj Hosp, Bangkok, Thailand

[14] Childrens Hosp 2, Ho Chi Minh City, Vietnam

[15] CART CRS, YRGCARE Med Ctr, Chennai, Tamil Nadu, India

[16] Hosp Raja Perempuan Zainab II, Bandar Kota Bharu, Kelantan, Malaysia

[17] Hosp Likas, Kota Kinabalu, Malaysia

[18] Udayana Univ, Sanglah Hosp, Bali, Indonesia

[19] Penang Hosp, George Town, Malaysia

[20] TREAT Asia AmfAR Fdn AIDS Res, Bangkok, Thailand

[21] New Hope Cambodian Children, Phnom Penh, Cambodia

[22] CART CRS, VHS Infect Dis Med Ctr, VHS, Chennai, Tamil Nadu, India

[23] Khon Kaen Univ, Fac Med, Dept Pediat, Div Infect Dis, Khon Kaen, Thailand

[24] Inst Rech Dev, PHPT IRD UMI 174, Chiang Mai, Thailand

[25] Chiang Mai Univ, Chiang Mai, Thailand

[26] Worldwide Orphans Fdn, Ho Chi Minh City, Vietnam

[27] UNSW Australia, Kirby Inst, Sydney, NSW, Australia

来源：

JOURNAL OF ADOLESCENT HEALTH | 2019年 / 65卷 / 05期

基金：

美国国家卫生研究院;

关键词：

HIV; Adolescent; Antiretroviral therapy; Monotherapy; Treatment interruption; LAMIVUDINE MONOTHERAPY; CHILDREN; THERAPY; VIRUS;

D O I：

10.1016/j.jadohealth.2019.05.025

中图分类号：

B844 [发展心理学（人类心理学）];

学科分类号：

040202 ;

摘要：

Purpose: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. Methods: Regional Asian data (2001-2016) were analyzed to describe PHIVA who experienced >= 2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. Results: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to >= 2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/mu L, HIV RNA >= 1,000 copies/mL, ART adverse event, and commencing ART age >= 10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. Conclusions: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes. (C) 2019 Society for Adolescent Health and Medicine. All rights reserved.

引用

页码：651 / 659

页数：9

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