The Pediatric infectious disease journal 2017 11 14() doi 10.1097/INF.0000000000001843
Data are limited on the selection and sequencing of second and third-line pediatric antiretroviral treatment (ART) in resource-limited settings. This study aimed to evaluate characteristics of African pediatric patients initiated on darunavir (DRV) and/or etravirine (ETR) through a specific drug donation program.
This was a cross-sectional study of baseline immunologic, virologic and demographic characteristics of children and adolescents initiating DRV- and/or ETR-based ART. Descriptive statistics were used.
Study enrolled 48 patients (45.8% female; median age=15 years (IQR 17.7-10.3)) at nine clinical sites in Zambia, Swaziland, Kenya and Lesotho. The majority (87.5%; n=42) had received ≥ 2 prior ART regimens; most (81.2%) had received lopinavir/ritonavir-based ART prior to switch. All patients had detectable HIV RNA (median=56,653 copies/mL). Forty seven (98.9%) patients had HIV genotype results: 41 (87.2%) had ≥1 nucleos(t)ide reverse transcriptase inhibitor (NRTI)-resistance mutation (RM), predominantly M184V (76.6%; n=36); 31 (65.9%) had ≥1 non-NRTI-RM, including 27 (57.4%) with ≥1 ETR-RM; 30 (63.8%) had ≥ 3 protease inhibitor RM, including 20 (42.6%) with ≥ 1 DRV-RM. For new ART regimens, DRV and raltegravir were most frequently prescribed (83.3%; n=40 on DRV and raltegravir, each). Eighteen patients (37.5%) were initiated on the NRTI-sparing ART.
In our study, a significant proportion of treatment-experienced African children and adolescents had one or more DRV-RM and ETR-RM. For the new regimen, more than a third of pediatric patients failing second-line ART, were prescribed NRTI-sparing regimens. Better understanding of the current approaches to pediatric ART sequencing in resource-limited settings is needed.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.