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A total of 5972 participants starting antiretroviral therapy (ART<\/jats:styled-content>) from 1998, aged < 20 years at the start of ART<\/jats:styled-content> for those with perinatal infection and 15\u201329 years for those with heterosexual infection, with ART<\/jats:styled-content> containing at least two nucleoside reverse transcriptase inhibitors (NRTI<\/jats:styled-content>s) and a nonnucleoside reverse transcriptase inhibitor (NNRTI<\/jats:styled-content>) or a boosted protease inhibitor (bPI<\/jats:styled-content>), were followed from ART<\/jats:styled-content> initiation until the most recent viral load (VL<\/jats:styled-content>) measurement. Virological failure of a drug was defined as VL > 500 HIV<\/jats:styled-content>\u20101 RNA<\/jats:styled-content> copies\/mL despite \u2265 4 months of use. TCVF<\/jats:styled-content> was defined as cumulative failure of two NRTI<\/jats:styled-content>s, an NNRTI<\/jats:styled-content> and a bPI<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>The median number of weeks between diagnosis and the start of ART<\/jats:styled-content> was higher in participants with perinatal HIV<\/jats:styled-content> infection compared with participants with heterosexually acquired HIV<\/jats:styled-content> infection overall [17 (interquartile range (IQR<\/jats:styled-content>) 4\u2013111) vs<\/jats:italic>. 8 (IQR<\/jats:styled-content> 2\u201338) weeks, respectively], and highest in perinatally infected participants aged 10\u201314 years [49 (IQR<\/jats:styled-content> 9\u2013267) weeks]. The cumulative proportion with TCVF<\/jats:styled-content> 5 years after starting ART<\/jats:styled-content> was 9.6% [95% confidence interval (CI<\/jats:styled-content>) 7.0\u221212.3%] in participants with perinatally acquired infection and 4.7% (95% CI<\/jats:styled-content> 3.9\u22125.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10\u201314 years when starting ART<\/jats:styled-content> (27.7%; 95% CI<\/jats:styled-content> 13.2\u221242.1%). Across all participants, significant predictors of TCVF<\/jats:styled-content> were those with perinatal HIV aged 10\u201314 years, African origin, pre\u2010ART AIDS<\/jats:styled-content>, NNRTI<\/jats:styled-content>\u2010based initial regimens, higher pre\u2010ART<\/jats:styled-content> viral load and lower pre\u2010ART CD<\/jats:styled-content>4.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The results suggest a beneficial effect of starting ART<\/jats:styled-content> before adolescence, and starting young people on boosted PI<\/jats:styled-content>s, to maximize treatment response during this transitional stage of development.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12411","type":"journal-article","created":{"date-parts":[[2016,9,14]],"date-time":"2016-09-14T09:58:59Z","timestamp":1473847139000},"page":"171-180","source":"Crossref","is-referenced-by-count":48,"title":["Higher rates of triple\u2010class virological failure in perinatally HIV<\/scp>\u2010infected teenagers compared with heterosexually infected young adults in Europe"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3176-5295","authenticated-orcid":false,"given":"A","family":"Judd","sequence":"first","affiliation":[{"name":"MRC Clinical Trials Unit University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Lodwick","sequence":"additional","affiliation":[{"name":"Department of Infection and Population Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Noguera\u2010Julian","sequence":"additional","affiliation":[{"name":"Institut de Recerca Pedi\u00e0trica Hospital Sant Joan de D\u00e9u Barcelona Spain"},{"name":"Departament de Pediatria Universitat de Barcelona Barcelona Spain"},{"name":"CIBER de Epidemiolog\u00eda y Salud P\u00fablica Ciberesp Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DM","family":"Gibb","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Immunology Our Lady's Children's Hospital Crumlin, Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Costagliola","sequence":"additional","affiliation":[{"name":"INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'\u00e9pid\u00e9miologie et de Sant\u00e9 Publique (IPLESP UMRS 1136) Sorbonne Universit\u00e9s Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Sabin","sequence":"additional","affiliation":[{"name":"Department of Infection and Population Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"van Sighem","sequence":"additional","affiliation":[{"name":"Stichting HIV Monitoring Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Ledergerber","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Hospital Epidemiology University of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Torti","sequence":"additional","affiliation":[{"name":"Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences University \u201cMagna Graecia\u201d Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Mocroft","sequence":"additional","affiliation":[{"name":"Department of Infection and Population Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Podzamczer","sequence":"additional","affiliation":[{"name":"HIV and STD Unit, Infectious Disease Service Hospital Universitari de Bellvitge. 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