Survival amongst HIV-positive children and adolescents in the United States has significantly improved, thanks to the use of triple antiretroviral therapy, according to a study published in the April 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study also found that the proportion of children needing to change their anti-HIV treatment regimes increased significantly between 1997 and 2001, and that the duration of each regimen decreased with each treatment change.
Investigators from the Pediatric Spectrum of HIV Disease Study wished to describe patterns of antiretroviral use and survival amongst children and adolescents recruited to the study between 1989 and 2001. Longitudinal data were collected prospectively from clinical charts and medical records. Information was also obtained on the number and duration of antiretroviral treatment regimens.
Data were analysed between 1989 and 2001 when examining trends in survival and from 1994 when the trends in antiretroviral use were studied.
In 1989, 649 children were included in the investigators’ analysis, 2196 in 1994, 2210 in 1997 and 2040 in 2001. The median age of the cohort increased from four years in 1994 to nine years in 2001. The proportion of African American and Hispanic children increased significantly between 1989 and 2001 (p
Only 6% of children were taking three or more antiretrovirals in 1996, increasing to 68% in 2000 and 66% in 2001. In 2001, an additional 12% of children were receiving dual antiretroviral therapy.
Significantly more white (73%) and Hispanic (70%) children were receiving three or more antiretrovirals in 2001 than African American children (63%, OR = 1.62 and 1.36 respectively).
From 1997 onwards, an increasing number of children had been treated with three or more triple drug regimens. In 1997, 81% of children were receiving their first antiretroviral combination, 15% their second, and 4% their third or greater. By 2001, 56% were taking their first regimen, 27% their second, and 17% their third or later. In addition, in 2001 3% of children were on their fifth or later regimen.
Unsurprisingly, the older a child was, the greater the odds that they would be heavily treatment experienced, with 13 year olds over twice as likely to be on their third or later regimen than children aged one to twelve (OR = 2.44). The investigators also found that white children were significantly more likely than either African American or Hispanic children to be taking their third or later antiretroviral combination (OR = 1.64).
In 2001, children taking their third or later regimen were also more likely to be taking newer antiretroviral drugs, including abacavir (OR = 2.43), Kaletra (OR = 3.07), amprenavir (OR = 1.64) and efavirenz (OR = 1.70).
The investigators divided the children in the study into three birth cohorts, each reflecting the availability of antiretroviral drugs. The cohorts were: 1989 – 93 (when most children were not treated with any antiretrovirals), 1993 – 1996 (when treatment with one or two antiretrovirals was common), and 1997 – 2001 (triple antiretroviral therapy). Unsurprisingly, the use of triple antiretroviral therapy was associated with a significant improvement in survival (p
“Triple-antiretroviral therapy use and survival rates have increased among HIV-infected children and adolescents in the PSD cohort. The proportion of patients using newer ARV drugs and the proportion receiving their third or greater triple-ARV regimen have also increased between 1994 and 2001”, write the investigators.
McConnell MS et al. Trends in antiretroviral therapy use and survival rates for a large cohort of HIV-infected children and adolescents in the United States, 1989 – 2001. J Acquir Immune Defic Syndr 38: 488 – 494, 2005.