Article
作者: Kobbe, Robin ; Musoro, Godfrey ; Cressey, Tim R ; Ngampiyaskul, Chaiwat ; Cotton, Mark F ; Atwine, Lorna ; Ahimbisibwe, Grace M ; Welch, Steven B ; Grossele, Tiziana ; Lugemwa, Abbas ; Ford, Deborah ; Sarfati, Tatiana ; Amuge, Pauline ; Behuhuma, Osee ; Wynne, Ben ; Colbers, Angela ; Rojo, Pablo ; Gibb, Diana M ; Ramsagar, Nastassja ; Bbuye, Dickson ; Chalermpantmetagul, Suwalai ; Kaudha, Elizabeth ; White, Ellen ; Bwakura-Dangarembizi, Mutsa ; Kityo, Cissy M ; Variava, Ebrahim ; Compagnucci, Alexandra ; Saïdi, Yacine ; Giaquinto, Carlo ; Archary, Moherndran ; Musiime, Victor ; Violari, Avy ; Makumbi, Shafic ; Ali, Shabinah ; Klein, Nigel ; Coelho, Alexandra ; Liberty, Afaaf ; Musoke, Philippa ; Barlow-Mosha, Linda ; Bernays, Sarah ; Turkova, Anna ; Puthanakit, Thanyawee ; Kekitiinwa, Adeodata R ; Mujuru, Hilda A ; Shakeshaft, Clare
BACKGROUND:Children with human immunodeficiency virus type 1 (HIV-1) infection have limited options for effective antiretroviral treatment (ART).
METHODS:We conducted an open-label, randomized, noninferiority trial comparing three-drug ART based on the HIV integrase inhibitor dolutegravir with standard care (non-dolutegravir-based ART) in children and adolescents starting first- or second-line ART. The primary end point was the proportion of participants with virologic or clinical treatment failure by 96 weeks, as estimated by the Kaplan-Meier method. Safety was assessed.
RESULTS:From September 2016 through June 2018, a total of 707 children and adolescents who weighed at least 14 kg were randomly assigned to receive dolutegravir-based ART (350 participants) or standard care (357). The median age was 12.2 years (range, 2.9 to 18.0), the median weight was 30.7 kg (range, 14.0 to 85.0), and 49% of the participants were girls. By design, 311 participants (44%) started first-line ART (with 92% of those in the standard-care group receiving efavirenz-based ART), and 396 (56%) started second-line ART (with 98% of those in the standard-care group receiving boosted protease inhibitor-based ART). The median follow-up was 142 weeks. By 96 weeks, 47 participants in the dolutegravir group and 75 in the standard-care group had treatment failure (estimated probability, 0.14 vs. 0.22; difference, -0.08; 95% confidence interval, -0.14 to -0.03; P = 0.004). Treatment effects were similar with first- and second-line therapies (P = 0.16 for heterogeneity). A total of 35 participants in the dolutegravir group and 40 in the standard-care group had at least one serious adverse event (P = 0.53), and 73 and 86, respectively, had at least one adverse event of grade 3 or higher (P = 0.24). At least one ART-modifying adverse event occurred in 5 participants in the dolutegravir group and in 17 in the standard-care group (P = 0.01).
CONCLUSIONS:In this trial involving children and adolescents with HIV-1 infection who were starting first- or second-line treatment, dolutegravir-based ART was superior to standard care. (Funded by ViiV Healthcare; ODYSSEY ClinicalTrials.gov number, NCT02259127; EUDRACT number, 2014-002632-14; and ISRCTN number, ISRCTN91737921.).