The Pediatric infectious disease journal · 2026
Use of Integrase Strand Transfer Inhibitors Among Children Living With HIV in Latin America and the Caribbean.
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Luque Marco Tulio, Du Liping, Rouzier Vanessa, Machado Daisy M, Pinto Jorge, Shepherd Bryan E, Castilho Jessica L, Caribbean, Central and South America Network for HIV Epidemiology
Аннотация
BACKGROUND: Limited data exist on integrase strand transfer inhibitor (INSTI) use among children. We assessed dolutegravir (DTG) and raltegravir (RAL) use and outcomes among Latin American and Caribbean children with HIV.
METHODS: Cohorts from Brazil, Haiti and Honduras contributed data for children (age <18 years) receiving care since the widespread availability of DTG and RAL (approximately 2013-2022). Trends and factors associated with INSTI (DTG/RAL) initiation were examined using multivariable logistic and Cox regression models among antiretroviral therapy (ART)-naïve and -experienced children, respectively. We compared viral and treatment outcomes among ART-naïve children by INSTI use with log-rank tests.
RESULTS: Among ART-naïve children, 77/110 started DTG, 5/109 started RAL and 91 started other ART. The proportion of ART-naïve children initiating DTG increased from 0% in 2016 to 93% (13/14) in 2022. Starting DTG was more likely in older ART-naïve children and in more recent calendar years (P ≤ 0.01). Among ART-experienced children, 122/273 switched to DTG, and 25/288 switched to RAL. More recent calendar year and a greater number of prior ART regimens were associated with a higher incidence of switch to DTG and RAL (P < 0.01). There was no statistical difference in virologic suppression among ART-naïve children by use or non-use of DTG; however, children started on DTG had a longer duration of the first regimen than those started on other ART (P < 0.01).
CONCLUSIONS: INSTI use among children has increased in parts of Latin American And Caribbean. As more children start INSTI regimens, further research is needed on their clinical impact.
METHODS: Cohorts from Brazil, Haiti and Honduras contributed data for children (age <18 years) receiving care since the widespread availability of DTG and RAL (approximately 2013-2022). Trends and factors associated with INSTI (DTG/RAL) initiation were examined using multivariable logistic and Cox regression models among antiretroviral therapy (ART)-naïve and -experienced children, respectively. We compared viral and treatment outcomes among ART-naïve children by INSTI use with log-rank tests.
RESULTS: Among ART-naïve children, 77/110 started DTG, 5/109 started RAL and 91 started other ART. The proportion of ART-naïve children initiating DTG increased from 0% in 2016 to 93% (13/14) in 2022. Starting DTG was more likely in older ART-naïve children and in more recent calendar years (P ≤ 0.01). Among ART-experienced children, 122/273 switched to DTG, and 25/288 switched to RAL. More recent calendar year and a greater number of prior ART regimens were associated with a higher incidence of switch to DTG and RAL (P < 0.01). There was no statistical difference in virologic suppression among ART-naïve children by use or non-use of DTG; however, children started on DTG had a longer duration of the first regimen than those started on other ART (P < 0.01).
CONCLUSIONS: INSTI use among children has increased in parts of Latin American And Caribbean. As more children start INSTI regimens, further research is needed on their clinical impact.