High Viral Suppression Rates and Attrition Rates Among Children With Perinatally Acquired HIV in the Thai National AIDS Program, 2023.

BACKGROUND

Early initiation of antiretroviral therapy (ART) can reduce HIV-related morbidity and mortality. We described treatment outcomes of children living with HIV identified through the early infant diagnosis (EID) program and linked to the Thai National AIDS Program (NAP).

METHODS

We used the Thai NAP database to conduct a cohort analysis of infants identified through the EID program who initiated ART from August 2014 to July 2018, with data cutoff on 31 December 2023. The Thai NAP is a national database linked to public hospitals in Thailand and a vital status registry. First-line ART was a lopinavir/ritonavir-based regimen; pediatric dolutegravir became available in May 2023. Attrition outcomes included death and loss-to-follow-up (LTFU). Virologic suppression was defined as plasma HIV RNA <200 copies/mL. The overall 7-year survival rate was estimated using the Kaplan-Meier estimate.

RESULTS

The median [interquartile range (IQR)] age at ART initiation was 3.3 (2.2-6) months for the 230 infants included. Twenty children [8.7%, 95% confidence interval (CI): 5.4-13.1] died at a median (IQR) age of 1.1 (0.6-3.0) years. LTFU was 44 (19.1%, 95% CI: 14.3-24.8) at the median (IQR) age of 3.6 (2.0-5.6) years. Overall, the 7-year survival rate was 90.7% (95% CI: 85.6-94.1). Among 166 children retained on ART, the median (IQR) age at the last visit was 7.7 (6.7-8.7) years. Of these, 107 (64.5%) children transitioned to dolutegravir-based regimens. Overall, virologic suppression was achieved in 144 children at the last visit, representing 62.6% of children who initiated ART and 86.7% of children who remained in care.

CONCLUSIONS

Children diagnosed with HIV through EID and linked to the Thai NAP had promising 7-year survival rates but substantial LTFU. Strategies to improve retention and re-engagement in care and are essential for better outcomes.