Raltegravir-based third-line ART in children and adolescents

Five case studies from Uganda showed good responses in children and adolescents receiving raltegravir-based third-line ART.

The number of HIV positive children and adolescents failing second-line ART is increasing, leading to resistance to protease inhibitors. There are limited data describing response to raltegravir (RAL)-based third-line ART among children in low- and middle-income settings.

Victor Musiime described outcomes of five children and adolescents receiving RAL-based ART at Joint Clinical Research Centre (JCRC), Kampala, Uganda. These case studies were presented at the Global HIV Clinical Forum: Integrase Inhibitors meeting before IAS2016.

The investigators performed a chart and database review of children and adolescents less than 18 years of age attending JCRC with second-line failure; triple class antiretroviral drug resistance (NRTI, NNRTI and PI); and on RAL-based third-line ART.

Those that fulfilled the selection criteria underwent an assessment of: weight, CD4 count, viral load and World Health Organization (WHO) clinical stage at baseline and after switching to RAL-based ART. The investigators also reviewed the case histories and genotypic resistance test results before switching. Follow up was for a minimum of six and maximum of 54 months.

Of five cases evaluated, four were male and one was female. They switched to RAL at 9-15 years of age. Their third-line regimens were: darunavir/ritonavir (DRV/r) + RAL, n=3; etravirine (ETR) + DRV/r+ RAL, n=1; tenofovir DF (TDF) + lamivudine (3TC) + DRV/r + RAL (n=1).

All had received 2 NRTIs + 1 NNRTI first-line, and lopinavir/ritonavir (LPV/r)- based second-line ART. Each case had developed: 5 or more NRTI resistance associated mutations (RAMs); 2 or 3 NNRTI RAMs (n=4) and 1 NNRTI RAM (n=1); and 3 or 4 PI RAMs.

The investigators reported that all of the five children and adolescents evaluated achieved viral suppression, as well as increased weights and CD4 counts; none developed new WHO stage III/IV events after switching to RAL-based third-line ART.

Musiime V et al. Response to raltegravir based third-line antiretroviral therapy among Ugandan children: A case series from an urban HIV clinic. Global HIV Clinical Forum: Integrase Inhibitors. 16 July 2016, Durban, South Africa. Oral abstract O_04.