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This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first\u2010line combination antiretroviral therapy (cART).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>CLHIV aged &lt;18\u00a0years, who were on first\u2010line cART for \u226512\u00a0months, and had virological suppression (two consecutive plasma viral load [pVL] &lt;50 copies\/mL) were included. Those who started treatment with mono\/dual antiretroviral therapy, had a history of treatment interruption &gt;14\u00a0days, or received treatment and care at sites with a pVL lower limit of detection &gt;50 copies\/mL were excluded. LLV was defined as a pVL 50 to 1000 copies\/mL, and VF as a single pVL &gt;1000 copies\/mL. Baseline was the time of the second pVL\u00a0&lt;\u00a050 copies\/mL. Cox proportional hazards models were performed to assess the association between LLV and VF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From January 2008 to September 2016, 508 CLHIV (55% female) were eligible for the study. At baseline, the median age was 9.6 (IQR: 7.0 to 12.3) years, cART duration was 1.4 (IQR: 1.3 to 1.8) years, 97% of CLHIV were on non\u2010nucleoside reverse transcriptase inhibitor\u2010based regimens, and the median CD4 was 25% (IQR: 20% to 30%). Over a median follow\u2010up time of 6.0 (IQR: 3.1 to 8.9) years from baseline, 86 CLHIV (17%) had ever experienced LLV, of whom 32 (37%) had multiple LLV episodes. Female sex, living in Malaysia (compared to Cambodia), having family members other than biological parents\/grandparents as a primary caregiver, and baseline CD4\u00a0&lt;\u00a025% increased risk of LLV. Overall, 115 children (23%) developed VF, corresponding to a rate of 4.0 (95%CI: 3.4 to 4.9) per 100 person\u2010years of follow\u2010up (PYFU). VF was greater among children who had ever experienced LLV compared with those who maintained virological suppression throughout the study period (8.9 vs. 3.3 per 100 PYFU;<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). In multivariable analyses, ever experiencing LLV was associated with increased risk of subsequent VF (adjusted hazard ratio: 3.01; 95%CI: 1.97 to 4.60).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LLV increased the risk of subsequent VF among Asian CLHIV who had previously been suppressed on first\u2010line cART. Adherence interventions and additional targeted pVL monitoring may be warranted among children with LLV to facilitate early detection of VF.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25550","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T19:49:31Z","timestamp":1594064971000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of low\u2010level viraemia on virological failure among Asian children with perinatally acquired HIV on first\u2010line combination antiretroviral treatment: a multicentre, retrospective cohort study"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3686-4623","authenticated-orcid":false,"given":"Tavitiya","family":"Sudjaritruk","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Chiang Mai University Chiang Mai Thailand"},{"name":"Research Institute for Health Sciences Chiang Mai University Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirinya","family":"Teeraananchai","sequence":"additional","affiliation":[{"name":"The HIV Netherlands Australia Thailand Research Collaboration The Thai Red Cross AIDS Research Centre Bangkok Thailand"},{"name":"Department of Statistics, Faculty of Science Kasetsart University Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azar","family":"Kariminia","sequence":"additional","affiliation":[{"name":"The Kirby Institute UNSW Australia Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4513-5924","authenticated-orcid":false,"given":"Keswadee","family":"Lapphra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nagalingeswaran","family":"Kumarasamy","sequence":"additional","affiliation":[{"name":"Chennai Antiviral Research and Treatment Clinical Research Site VHS\u2010Infectious Diseases Medical Centre VHS Chennai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moy S","family":"Fong","sequence":"additional","affiliation":[{"name":"Hospital Likas Kota Kinabalu Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rawiwan","family":"Hansudewechakul","sequence":"additional","affiliation":[{"name":"Chiangrai Prachanukroh Hospital Chiang Rai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torsak","family":"Bunupuradah","sequence":"additional","affiliation":[{"name":"The HIV Netherlands Australia Thailand Research Collaboration The Thai Red Cross AIDS Research Centre Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penh Sun","family":"Ly","sequence":"additional","affiliation":[{"name":"National Centre for HIV\/AIDS, Dermatology and STDs Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Revathy A","family":"Nallusamy","sequence":"additional","affiliation":[{"name":"Penang Hospital Penang Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-3285","authenticated-orcid":false,"given":"Annette H","family":"Sohn","sequence":"additional","affiliation":[{"name":"TREAT Asia\/amfAR \u2013 The Foundation for AIDS Research Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virat","family":"Sirisanthana","sequence":"additional","affiliation":[{"name":"Research Institute for Health Sciences Chiang Mai University Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"TREAT Asia Pediatric HIV Observational Database of IeDEA Asia\u2010Pacific","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,6]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Panel on antiretroviral therapy and medical management of children living with HIV.Guidelines for the use of antiretroviral agents in pediatric HIV infection[cited 2019 Nov 15]. 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