Study highlights challenges of maintaining long-term viral
suppression in children
An MRC-funded study
supported by EuroCoord published in
the Lancet, has shown that 12% of children with HIV
develop triple class virological failure by 5 years after starting
antiretroviral therapy (ART), and 20% by 8 years. Triple class
failure is failure of the three original drug classes (nucleoside
or nucleotide reverse transcriptase inhibitors (NRTIs), non-NRTIs
(NNRTIs), and protease inhibitors).
Although these rates are relatively low, highlighting the great
success of antiretroviral treatment in children, they are higher
than in adults. Findings raise concerns about the proportion of
children starting ART who are likely to maintain viral suppression
for life, given that this group is likely to be receiving ART for
life, and despite the potential availability of newer drugs from
other classes.
A total of 1007 European children were identified in 14 COHERE
cohorts within EuroCoord, making this the first study to undertake
a formal assessment of the incidence or consequences of
triple-class failure in children within a large cohort
collaboration.
The authors speculate that the increased rate of triple-class
virological failure found in this study might be explained by lower
virological suppression rates in children than in adults, absence
of alternative regimens, adherence issues related to taste and
formulation, a tendency for delays in treatment switches in
children, and various social factors.
As such, the study authors conclude: “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.”