Rate of antiretroviral virological failure higher among children living with HIV/AIDS than adults, study finds

Apr 21 2011

One in eight children living with HIV/AIDS "experiences triple-class virological failure - meaning the virus becomes resistant to multiple drugs - within five years of starting antiretroviral treatment," according to a study published Wednesday in the Lancet, HealthDay News/MSN reports. The "failure rate is higher than in adults and highlights the challenge of maintaining viral load suppression in young patients who begin antiretroviral therapy so early in life, the researchers said," according to the news service (Preidt, 4/19).

For the study, researchers tracked the health of a group of more than 1,000 European children "infected perinatally with HIV who started antiretroviral therapy with three or more drugs between 1998 and 2008, were younger than 16, and had at least four months of follow-up," MedPage Today reports (Smith, 4/19).

Based on their analysis, the authors found "[t]he failure rate in the three main classes of drugs - known as nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs), and protease inhibitors - was 12% within five years of starting," the Guardian reports (Boseley, 4/20). "Of 686 children starting ART with NRTIs and either a NNRTI or ritonavir-boosted protease inhibitor the rate of failure was more than twice as high than in adults with heterosexually transmitted HIV," according to a Lancet press release (4/19). The researchers also found that children who began ART at a later age were "more likely to experience failure," HealthDay News/MSN adds (4/19).

"The rate of virological 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," the study authors write, according to a Lancet press release. "There is continued need for strategies to promote optimum drug adherence in children, caregivers, and young people to minimise the likelihood of triple-class virological failure, and for development of suitable new drugs and formulations to optimise the treatment of children with treatment failure. Fixed-drug combinations and simplification of strategies could be important ways to maintain treatment options while children move through adolescence and reach adulthood," they add (4/19).

"The development of new fixed-drug formulations is hindered by scarcity of clinical data about the use of specific drugs in children," write the authors of a related Lancet comment, where they call for drug makers and researchers to prioritize the development of antiretrovirals for children living with HIV/AIDS. "The neglect of children in the global HIV/AIDS response runs from clinical research to programme implementation, with children receiving a lower standard of care than do adults. Paediatric HIV/AIDS is, for the most part, a disease of developing nations, where there are few profit prospects for drug companies. … paediatric HIV/AIDS is a neglected disease," they conclude (Calmy/Ford, 4/20).