scholarly journals Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment

2020 ◽  
Vol 36 (7) ◽  
pp. 566-573
Author(s):  
Vinie Kouamou ◽  
Bhavini Varyani ◽  
Tinei Shamu ◽  
Tichaona Mapangisana ◽  
Cleophas Chimbetete ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Young Adults ◽  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Adolescents And Young Adults ◽  
Line Treatment ◽  
Second Line ◽  
First Line

scholarly journals Drug resistance and optimizing dolutegravir regimens for adolescents and young adults failing antiretroviral therapy

AIDS ◽  
2019 ◽  
Vol 33 (11) ◽  
pp. 1729-1737 ◽  
Author(s):  
Vinie Kouamou ◽  
Justen Manasa ◽  
David Katzenstein ◽  
Alan M. McGregor ◽  
Chiratidzo E. Ndhlovu ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Young Adults ◽  
Antiretroviral Therapy ◽  
Adolescents And Young Adults

scholarly journals Resistance in Pediatric Patients Experiencing Virologic Failure With First-line and Second-line Antiretroviral Therapy

2013 ◽  
Vol 32 (6) ◽  
pp. 644-647 ◽  
Author(s):  
Catherine Orrell ◽  
Julie Levison ◽  
Andrea Ciaranello ◽  
Linda-Gail Bekker ◽  
Daniel R. Kuritzkes ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pediatric Patients ◽  
Virologic Failure ◽  
Second Line ◽  
First Line ◽  
Second Line Antiretroviral Therapy

scholarly journals Diverse Human Immunodeficiency Virus–1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited Settings

2019 ◽  
Vol 71 (7) ◽  
pp. e170-e177 ◽  
Author(s):  
Carole L Wallis ◽  
Michael D Hughes ◽  
Justin Ritz ◽  
Raquel Viana ◽  
Carlos Silva de Jesus ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Cd4 T Cell ◽  
Second Line ◽  
Drug Classes ◽  
Immunodeficiency Virus ◽  
Third Line ◽  
Second Line Antiretroviral Therapy

Abstract Background Human immunodeficiency virus (HIV) drug resistance profiles are needed to optimize individual patient management and to develop treatment guidelines. Resistance profiles are not well defined among individuals on failing second-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC). Methods Resistance genotypes were performed during screening for enrollment into a trial of third-line ART (AIDS Clinical Trials Group protocol 5288). Prior exposure to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs and confirmed virologic failure on a protease inhibitor–containing regimen were required. Associations of drug resistance with sex, age, treatment history, plasma HIV RNA, nadir CD4+T-cell count, HIV subtype, and country were investigated. Results Plasma HIV genotypes were analyzed for 653 screened candidates; most had resistance (508 of 653; 78%) to 1 or more drugs. Genotypes from 133 (20%) showed resistance to at least 1 drug in a drug class, from 206 (32%) showed resistance to at least 1 drug in 2 drug classes, and from 169 (26%) showed resistance to at least 1 drug in all 3 commonly available drug classes. Susceptibility to at least 1 second-line regimen was preserved in 59%, as were susceptibility to etravirine (78%) and darunavir/ritonavir (97%). Susceptibility to a second-line regimen was significantly higher among women, younger individuals, those with higher nadir CD4+ T-cell counts, and those who had received lopinavir/ritonavir, but was lower among prior nevirapine recipients. Conclusions Highly divergent HIV drug resistance profiles were observed among candidates screened for third-line ART in LMIC, ranging from no resistance to resistance to 3 drug classes. These findings underscore the need for access to resistance testing and newer antiretrovirals for the optimal management of third-line ART in LMIC.

Practice patterns in children, adolescents, and young adults with mycosis fungoides: Single institution study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19553-e19553
Author(s):  
Madeline Hooper ◽  
Yumeng Zhang ◽  
Eric Taylor ◽  
Lucia Seminario-Vidal ◽  
Lubomir Sokol
Keyword(s):  
Young Adults ◽  
Early Stage ◽  
Adolescents And Young Adults ◽  
Disease Stage ◽  
Topical Steroids ◽  
Second Line ◽  
First Line ◽  
Early Stage Disease ◽  
Disease Response ◽  
Stage Disease

e19553 Background: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, but management remains heterogenous. MF management is based on disease stage, comorbidities, availability, and physician preference. Few studies have assessed treatment in children, adolescents, and young adults because prognosis in these groups is generally favorable; however, optimizing therapeutic protocols for these patients will improve clinical care and reduce adverse effect incidence. Here, we retrospectively describe the practice patterns and disease response for the child, adolescent, and young adult with MF. Methods: We retrospectively reviewed clinical data on 46 patients younger than 40 years with MF treated at Moffitt Cancer Center between 2009 and 2019. Mean time to next therapy (mTTNT) was used as a surrogate marker for the duration of clinical benefit. Group differences in mTTNT for patients with early-stage MF was assessed using Kaplan-Meier analysis. P-values were calculated using the log-rank test. Results: Overall, mean age was 29.2 years (range: 6.6-39.8). Topical steroids (47.8%) and narrowband-UVB (nbUVB) (19.6%) were the most utilized first line treatments regardless of disease stage. Forty patients had early-stage MF (stage IA-IIA). Among them, mean age was 27.8 years (6.6-36.6); 55% received topical steroids and 22.5% received nbUVB first line. These patients received a mean of three (1-7) unique therapies throughout their treatment course. Other reported topicals were retinoids, nitrogen mustard and pimecrolimus. Systemic retinoids were used in one early-stage case. Used first line in early-stage disease, topical therapy resulted in a mTTNT of 25 months ( p= 0.015); mTTNT after combination and systemic therapy was 12 and 5.5 months. As second line treatment, phototherapy resulted in a mTTNT of 58 months, but this finding was not statistically significant ( p= 0.11). Topical and systemic agents used second line resulted in mTTNT of 34 and 33 months. Six patients had advanced-stage MF (stage IIB-IVB) with a mean age of 27.6 years (19.9-35.8), two of which died from the disease. Each patient received a different first line therapy: topical nitrogen mustard, systemic steroids, systemic retinoids, radiation, psoralen and UVA light, or CHOP chemotherapy. Mean number of therapies administered to this cohort was five (2-9). Conclusions: In children, adolescents, and young adults with MF, topical and phototherapies were used more frequently than systemic therapies or radiation. In early-stage disease, the longest clinical response was achieved with topical treatments. Used second line, phototherapy demonstrated promising disease response trends compared to those of other modalities. Systemic therapy does not produce durable disease response in the first line setting; however, its utility in advanced-stage disease and as a second line agent requires further research.

scholarly journals Implication of First-Line Antiretroviral Therapy Choice on Second-Line Options

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Seema T Meloni ◽  
Chika K Onwuamah ◽  
Oche Agbaji ◽  
Beth Chaplin ◽  
David O Olaleye ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Transcriptase Inhibitor ◽  
Second Line ◽  
Resistance Mutations ◽  
First Line ◽  
Paired Samples ◽  
Therapy Choice ◽  
Significant Difference ◽  
The Impact

Abstract Background Although there are a number of studies comparing the currently recommended preferred and alternative first-line (1L) antiretroviral therapy (ART) regimens on clinical outcomes, there are limited data examining the impact of 1L regimen choice and duration of virologic failure (VF) on accumulation of drug resistance mutations (DRM). The patterns of DRM from patients failing zidovudine (AZT)-containing versus tenofovir (TDF)-containing ART were assessed to evaluate the predicted susceptibility to second-line (2L) nucleoside reverse-transcriptase inhibitor (NRTI) backbone options in the context of an ongoing programmatic setting that uses viral load (VL) monitoring. Methods Paired samples from Nigerian ART patients who experienced VF and switched to 2L ART were retrospectively identified. For each sample, the human immunodeficiency virus (HIV)-1 polymerase gene was sequenced at 2 time points, and DRM was analyzed using Stanford University’s HIVdb program. Results Sequences were generated for 191 patients. At time of 2L switch, 28.2% of patients on AZT-containing regimens developed resistance to TDF, whereas only 6.8% of patients on TDF-containing 1L had mutations compromising susceptibility to AZT. In a stratified evaluation, patients with 0–6 months between tested VL samples had no difference in proportion compromised to 2L, whereas those with >6 months between samples had a statistically significant difference in proportion with compromised 2L NRTI. In multivariate analyses, patients on 1L AZT had 9.90 times higher odds of having a compromised 2L NRTI option than patients on 1L TDF. Conclusions In the context of constrained resources, where VL monitoring is limited, we present further evidence to support use of TDF as the preferred 1L NRTI because it allows for preservation of the recommended 2L NRTI option.

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