Prevalence and outcomes of recycling NNRTIs despite documented NNRTI resistance in HIV-infected children and youth.
AIDS Patient Care STDS
; 28(1): 10-4, 2014 Jan.
Article
em En
| MEDLINE
| ID: mdl-24428795
ABSTRACT
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are commonly used in pediatric patients; however, rapid development of resistance, due to non-adherence and cross-resistance, results in their discontinuation and limits their recycling. We evaluated the clinical experience of recycling NNRTIs despite documented NNRTI resistance (NNRTI-R), and examined virologic and CD4 cell count outcomes among participants enrolled in Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY), a national HIV-infected pediatric cohort. We conducted a retrospective analysis of LEGACY participants with major NNRTI-R. Using chi-square analyses and logistic regression, we examined demographic and clinical factors associated with prescription of NNRTIs despite documented NNRTI-R, and associated changes in plasma HIV RNA viral load and CD4 cell counts. Sixteen of 133 (12%) participants with documented NNRTI-R re-started NNRTIs for a median of 370 days (IQR 105-919) with a median 402 days (IQR 70-841) between documentation of NNRTI-R to NNRTI recycling. Participants recycling NNRTIs were less likely to have documented past non-adherence (40.0% vs. 69.2%; p = 0.02). Among twelve patients with virologic data at 24 (± 8) weeks; seven (58.3%) experienced virologic suppression while on the recycled NNRTI-based regimens. Of the five who failed to suppress, three with subsequent genotyping developed additional NNRTI-R mutations compromising higher generation NNRTIs. While NNRTI's were recycled in only a small fraction of LEGACY participants harboring NNRTI-R mutations, such recycling increased the risk of inducing further resistance mutations that compromised use of higher generation NNRTIs.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
RNA Viral
/
Infecções por HIV
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HIV-1
/
Inibidores da Transcriptase Reversa
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Fármacos Anti-HIV
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Farmacorresistência Viral
Tipo de estudo:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
Limite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
AIDS Patient Care STDS
Assunto da revista:
DOENCAS SEXUALMENTE TRANSMISSIVEIS
/
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2014
Tipo de documento:
Article