Children appear more likely to fail triple-drug ART regimen

PLATO II Project Team. Lancet. 2011;doi:10.1016/S0140-6736(11)60208-0.

As much as 12% of children develop triple-class virologic failure 5 years after starting an antiretroviral therapy regimen, according to data published online.

The study, conducted by Ali Judd, MD, of the UK Medical Research Council Clinical Trials Unit, London, and researchers on the Pursuing Later Treatment Options II (PLATO II) project looked at 1,007 European children who were identified in 14 Collaboration of Observational HIV Epidemiological Research Europe (COHERE) cohorts. The children enrolled in the trial were aged younger than 16 years and began ART between 1998 and 2008.

Twenty-four percent of the cohort was exposed to triple-class therapy. Five years after ART initiation, the rate of triple-class failure across the whole cohort was 12%, the researchers said.

The rate of failure was more than twice as high than in adults with heterosexually transmitted HIV, they said.

“The rate of virologic failure of the three original drug classes seen in this study shows the challenge of maintaining lifelong viral suppression in children who start ART much earlier in life than do adults,” Judd and colleagues wrote. “Further detailed analysis is needed to compare rates of switching to second-line ART and viral suppression on second-line ART between adults and children, and to compare the development of resistance.”

In a linked editorial, Alexandra L. Calmy, MD, and Nathan Ford, MD,both of Médecins Sans Frontières, Geneva, noted the importance of ART regimens, particularly in the developing world.

Disclosure: Funding for the study was provided through the UK Medical Research Council award. The researchers reported no relevant financial disclosures.

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