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. Author manuscript; available in PMC: 2020 Mar 25.
Published in final edited form as: Lancet HIV. 2019 Feb;6(2):e105–e115. doi: 10.1016/S2352-3018(18)30319-9

Table 3:

Factors associated with switching to second-line ART

All children (main analysis; n=93 351)
 Subset of cohorts that recorded CD4% or CD4 cell count and bodyweight at ART initiation (sensitivity analyses; n=39 724)
Univariable analysis Multivariable analysis Univariable analysis Multivariable analysis, not including immunodeficiency for age and weight-for-age Z score Multivariable analysis, including immunodeficiency for age and weight-for-age Z score
Patient-level factors
Sex p<0·0001 p<0·0001 p<0·0001 p<0·0001 p<0·0001
 Female vs male 0·79 (0·74–0·84) 0·78 (0·73–0·83) 0·80 (0·75–0·86) 0·79 (0·74–0·84) 0·81 (0·74–0·88)
Age, years p<0·0001 p<0·0001 p<0·0001 p<0·0001 p<0·0001
 <3 0·61 (0·56–0·66) 0·63 (0·58–0·68) 0·58 (0·54–0·63) 0·68 (0·62–0·74) 0·62 (0·54–0·70)
 3–5 0·77 (0·71–0·84) 0·73 (0·67–0·79) 0·78 (0·71–0·85) 0·75 (0·69–0·82) 0·71 (0·64–0·79)
 6–9 1 1 1 1 1
 ≥10 1·24 (1·11–1·51) 1·15 (0·98–1·35) 1·17 (1·00–1·37) 1·17 (0·99–1·38) 1·26 (1·05–1·51)
Known AIDS diagnosis p=0·16 p=0·10 p=0·16 p=0·87 p=0·96
 Yes vs no 0·96 (0·90–1·02) 0·95 (0·88–1·01) 1·05 (0·98–1·12) 1·01 (0·94–1·08) 1·00 (0·88–1·16)
Immunodeficiency for age ·· ·· p<0·0001 ·· p<0·0001
 None ·· ·· 1·07 (0·90–1·27) ·· 0·91 (0·75–1·10)
 Mild ·· ·· 1·21 (1·00–1·46) ·· 1·16 (0·85–1·43)
 Advanced ·· ·· 1 ·· 1
 Severe ·· ·· 1·39 (1·21–1·58) ·· 1·40 (1·21–1·62)
Weight-for-age Z score ·· ·· p=0·38 ·· p=0·17
 ≤−2 ·· ·· 0·95 (0·87–1·03) ·· 1·07 (0·97–1·17)
 >−2 to 0 ·· ·· 1 ·· 1
 >0 ·· ·· 1·00 (0·87–1·16) ·· 0·93 (0·80–1·09)
Initial ART regimen p=0·004 p<0·0001 p<0·0001 p<0·0001 p<0·0001
 Protease inhibitor based vs NNRTI based 1·15 (1·05–1·26) 0·70 (0·63–0·79) 0·68 (0·61–0·76) 0·51 (0·45–0·58) 0·58 (0·49–0·68)
Calendar year p<0·0001 p<0·0001 p<0·0001 p<0·0001 p<0·0001
 ≤2004 2·96 (2·70–3·24) 1·39 (1·26–1·53) 2·28 (2·08–2·51) 1·41 (1·27–1·56) 1·41 (1·24–1·61)
 2005–07 1·45 (1·35–1·57) 1·26 (1·17–1·36) 1·27 (1·17–1·38) 1·18 (1·08–1·28) 1·18 (1·07–1·30)
 2008–10 1 1 1 1 1
 ≥2011 0·55 (0·47–0·63) 0·61 (0·53–0·71) 0·49 (0·41–0·58) 0·53 (0·44–0·62) 0·59 (0·48–0·73)
Cohort-level factors
Cohort monitoring strategy p<0·0001 p<0·0001 p<0·0001 p<0·0001 p<0·0001
 Routine CD4 and viral load 4·57 (4·18–5·00) 2·66 (2·22–3·19) 2·81 (2·55–3·10) 1·90 (1·60–2·26) 2·37 (1·94–2·89)
 Routine CD4 and targeted viral load 2·18 (1·95–2·43) 1·95 (1·75–2·18) 1·29 (1·15–1·45) 1·29 (1·13–1·46) 1·43 (1·24–1·66)
 Routine CD4 only 1 1 1 1 1
 Clinical only 0·75 (0·62–0·91) 0·68 (0·56–0·83) ·· ·· ··
Country-income group p<0·0001 p=0·0017 p<0·0001 p=0·22 p=0·44
 Low 1 1 1 1 1
 Lower-middle 1·04 (0·94–1·14) 1·09 (0·98–1·21) 1·01 (0·90–1·12) 1·09 (0·96–1·20) 1·01 (0·88–1·16)
 High and upper-middle 3·21 (2·98–3·47) 1·33 (1·13–1·56) 2·26 (2·09–2·46) 1·14 (0·97–1·33) 0·87 (0·71–1·08)
Geographical region p<0·0001 p<0·0001 p<0·0001 p<0·0001 p<0·0001
 USA 4·16 (3·20–5·42) 4·04 (3·07–5·32) 3·01 (1·84–4·93) 2·73 (1·63–4·58) 4·39 (2·28–8·46)
 Europe 2·30 (2·07–2·56) 2·22 (1·97–2·49) 2·05 (1·83–2·29) 1·84 (1·63–2·09) 2·22 (1·87–2·63)
 Latin America 1·23 (1·03–1·49) 1·73 (1·40–2·15) 1·28 (1·05–1·55) 1·59 (1·27–2·00) 1·88 (1·46–2·42)
 Asia 1·27 (1·15–1·40) 1·38 (1·23–1·54) 1·18 (1·07–1·31) 1·06 (0·94–1·18) 0·86 (0·74–1·01)
 Southern Africa 1 1 1 1 1
 Rest of sub-Saharan Africa 0·35 (0·33–0·38) 0·89 (0·74–1·07) 0·47 (0·44–0·52) 0·69 (0·57–0·83) 0·66 (0·52–0·84)

Data are subdistributional hazard ratios (95% CIs) unless otherwise stated. CD4 means CD4% or CD4 cell count. ART=antiretroviral therapy. NNRTI=non-nucleoside reverse transcriptase inhibitor.