Background Antiretroviral therapy (ART) has resulted in increasing median survival times in HIV-infected individuals by sustaining viral load suppression. Since children and adolescents are likely to have long-term exposure to ART, it is important to understand patterns of drug use to investigate the emergence of unintended sequelae.

Aim To investigate patterns of ART in children and adolescents.

Study Design Cross-sectional analysis of HIV-infected subjects aged 2–22 years across 15 clinical sites in Belgium, Italy and Poland.

Method Prevalence of both “ever-use” and “current-use” (at recruitment) of ART drug classes: nucleoside analogue reverse transcriptase inhibitors (NRTIs); non-nucleoside analogue reverse transcriptase inhibitors (NNRTIs); and protease inhibitors (PIs), and individual drugs were investigated.

Results Among 468 participants (51% female) the median age was 13.5 years (IQR 9.9–17.0) with 320(68%) of white ethnicity and 104 (22%) Black African. Overall, 291(62%) were virologically suppressed (HIV-RNA ≤50copies/ml) at enrolment and 35(7%) had severe immuno-suppression (age-stratified CD4%). Only 23 (5%) subjects were ART-naive (median age=10.0 years, IQR; 6.1–14.3); 15 had experienced moderate or severe immuno-suppression/HIV-disease, with 15 having detectable viral load at recruitment. Of the ever-treated subjects, 98% (n=436) had received zidovudine or lamivudine in the past and 72% (n=324) currently; 82% (n=368) and 72% (n=323) had been ever-exposed to PIs and NNRTIs, respectively. Median and modal lifetime number of drugs was six. Over their lifetime, 119 (27%) subjects had been exposed to ≥8 drugs (median age=15.7 years, IQR; 12.3–18.0). Age was associated with duration of total drug use (p<0.001), with median age of ART initiation of 3.6 years (IQR: 1.1–7.4) Median total duration of drug use was 8.7 years (IQR=5.7–11.2 years). Nine percent of currently treated subjects (n=38) had suboptimal management, defined as NRTIs-only (24 showing evidence of incomplete viral suppression), and 91% (n=384) had treatment with combination ART (cART).The most common PI in current-use was kaletra (n=170, 40%), possibly reflecting its availability as the only combination PI accessible in tablet/liquid form. Current use of PIs was associated (p<0.001) with hypercholesterolaemia in adjusted analyses indicating a long-term consequence of specific ART.

Conclusions The majority of subjects had been managed with ART, with first exposure occurring at an early age. At least a quarter of participants had been treated with multiple individual drugs suggesting cumulative exposure and switching between regimens. The most prevalent treatment approach at recruitment was cART. However, there is evidence of continued use of suboptimal management strategies, and hypercholesterolaemia being associated with PI use.