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A third of children with HIV virological rebound resuppress their virus without switching treatment

30 April 2015

In March 2015, researchers published a study in the Lancet HIV which found that a third of children with HIV virological rebound resuppressed their virus without changing their medication.  These findings suggest that doctors should consider keeping children on their current HIV medication and support them to take their drugs regularly, before changing their treatment. 

This observational study used data reported to the Collaborative HIV Paediatric Study (CHIPS), which is a national database that monitors all children receiving paediatric HIV care in the UK and Ireland.

The study included 900 children under 18, who were infected with HIV and who had started taking antiretroviral therapy for the first time since being included in the CHIPS database.  Antiretroviral therapy (or ART) is a combination of several medicines, which are taken to keep the virus under control.  There are many different possible combinations of antiretroviral drugs available. 

Of these 900 children, 19% (170 children) had virological rebound.  This means that levels of virus in these children's bodies had risen, even though ART had previously effectively suppressed the virus. 

Researchers found that about half of the 170 children with virological rebound changed the combination of ART drugs they were taking in order to resuppress the HIV virus.  However, in about a third of the children, the levels of HIV in their body returned to a safe level without changing their treatment.

The proportion of children who resuppressed their virus without switching treatment was higher than researchers expected, although similar findings have been reported in studies in adults. 

The study also found that within the group of patients who did not change their medication, 71% showed no sign that they had become resistant to antiretroviral drugs.  In the group that did change their drugs, only 10% of the children had no signs of ART resistance.  This finding suggests that problems with drug resistance may have led some of the patients to change their medication.

Various studies have shown that the numbers of children who have virological failure within 2 years of beginning ART are quite high: approximately 33-38%.  This has raised concerned about treating children with HIV long-term.  Children infected with HIV are recommended to start ART immediately (from infancy) and will need lifelong treatment.  However, there are a limited number of ART drugs that are suitable for children.  If children become resistant to some of these treatments, their options become even more limited.

The findings from this study give doctors the option to keep children who are not resistant to their current treatment on the same medication and support them to keep taking their drugs regularly, before making the decision to switch.