Predictors of treatment failure in children living with HIV starting first-line antiretroviral therapy in the ODYSSEY trial
Wyncoll, James Kamolrattana, Rujirek Archary, Moherndran Mujuru, Hilda A Kekitiinwa, Adeodata R Violari, Avy Na-Rajsima, Sathaporn Lugemwa, Abbas Variava, Ebrahim Cotton, Mark
Wyncoll, James
Kamolrattana, Rujirek
Archary, Moherndran
Mujuru, Hilda A
Kekitiinwa, Adeodata R
Violari, Avy
Na-Rajsima, Sathaporn
Lugemwa, Abbas
Variava, Ebrahim
Cotton, Mark
Abstract
BACKGROUND: Data on predictors of treatment failure in children starting antiretroviral therapy (ART) are limited, particularly on dolutegravir-based regimens (DTG).
METHODS: ODYSSEY demonstrated superior efficacy of DTG versus standard-of-care (SOC). We assessed predictors at ART initiation of treatment failure by 96 weeks.
RESULTS: 381 children started first-line ART (82% African). At ART-initiation, median age was 10.5 years (IQR:6.5,14.0, 67<3 years), CD4% 20% (IQR:12, 28), BMI-for-age Z-score -0.58 (IQR:-1.48,+0.25). 189 children started DTG, 192 started SOC (91%≥3 years started efavirenz; 79%<3 years started lopinavir). 75 children experienced treatment failure (24 DTG, 51 SOC). Failure risk was lower on DTG than SOC (HR=0.47, 95%CI:0.29-0.77, p=0.002). Lower BMI-for-age Z-score (HR=0.82 for each unit gain, 95%CI:0.70-0.96, p=0.01) and being at an African site (HR=2.09, 95%CI:0.82-5.31, p=0.09) were associated with higher failure risk. Risk was also higher at younger ages with the steepest increase in the youngest children, and increased at lower CD4%, with a stronger CD4% effect at younger ages. At CD4%=20, hazard ratios relative to age 10 years were 2.40 (95%CI: 1.58-3.65) at age 1 year, 1.30 (95%CI: 1.15-1.48) at age 5 years and 0.80 (95%CI: 0.72-0.89) at age 18 years. At age 1 year, hazard ratios relative to CD4%=20 were 1.39 (95%CI: 1.16-1.66) at CD4%=15, and 0.52 (95%CI: 0.36-0.75) at CD4%=30; at age 10 corresponding estimates were 1.07 (95%CI: 0.94-1.20) at CD4%=15, and 0.88 (95%CI: 0.69-1.13) at CD4%=30.
CONCLUSIONS: Young age, low BMI-for-age and low CD4% at ART initiation predicted higher risk of treatment failure and can guide targeted support.
MIDER Authors
Affiliations
Date
2026-04-10
Type
Article
Subject
Collections
Citation
Wyncoll J, Kamolrattana R, Archary M, Mujuru HA, Kekitiinwa AR, Violari A, Na-Rajsima S, Lugemwa A, Variava E, Cotton M, Kityo CM, Königs C, Behuhuma NO, Welch S, Saïdi Y, Marques L, Ahimbisibwe GM, Houlden L, Giaquinto C, Rojo P, Gibb DM, Puthanakit T, Turkova A, White E, Ford D. Predictors of treatment failure in children living with HIV starting first-line antiretroviral therapy in the ODYSSEY trial. Clin Infect Dis. 2026 Apr 10:ciag232. doi: 10.1093/cid/ciag232. Epub ahead of print.