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Wondifraw EB, Tebeje NB, Akanaw W, Chanie ES. Predictors of first-line antiretroviral treatment failure among children on antiretroviral therapy at the University of Gondar comprehensive specialised hospital, North-west, Ethiopia: a 14-year long-term follow-up study. BMJ Open 2022; 12:e064354. [PMID: 36600440 PMCID: PMC9772663 DOI: 10.1136/bmjopen-2022-064354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the incidence and predictors of first-line human immune deficiency virus treatment failure among human immune deficiency virus-infected children at the University of Gondar comprehensive specialised hospital in Ethiopia. DESIGN A retrospective follow-up study. SETTING University of Gondar comprehensive specialised hospital, North-west, Ethiopia. PARTICIPANTS Children were among the HIV infected from January 2005 to December 2018. There were 336 children included in the study. The data were entered into EPi Info V.7.2 and then exported to STATA V.14.0 Software for analysis. Both bivariable and multivariable analyses with Cox proportional hazards models were used to identify the predictors of treatment failure. PRIMARY OUTCOME MEASURES Predictors of first-line antiretroviral treatment failure among children on antiretroviral therapy (ART) during 14 years long-term follow-up study. RESULT A total of 336 human immunodeficiency virus-infected children participated in this study with 27 058 child years of observation. The overall incidence rate was 2.1 (95% CI 1.57 to 2.78) per 100 child years. Poor adherence (adjusted HR (AHR); 6.5 (95% CI 2.03 to 21.39)), fair adherence (AHR; 6.55 (95% CI 2.64 to 16.53), the presence of opportunistic infection (AHR; 4.22 (95% CI 1.44 to 12.30), clinical staging of III/IV (AHR; 3.08 (95% CI 1.17 to 8.08) and a baseline CD4 count less than 200 cells/mm3 (AHR; 3.61 (95% CI 1.12 to 11.54)). CONCLUSION The incidence of first-line ART failure was found to be high. Baseline opportunistic infection, poor and fair adherence, advanced WHO clinical staging III/IV and a CD4 count less than 200 cells/mm3 were all predictors of first-line treatment failure. Early identification of associated factors and monitoring treatment failure has to be important for the optimal management of HIV-infected children who are receiving ART and to prevent further complications.
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Affiliation(s)
| | | | - Worknesh Akanaw
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Ermias Sisay Chanie
- Pedatrics and child health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
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Anito AA, Lenjebo TL, Woticha E, Solomon F. Magnitude of Viral Load Suppression and Associated Factors among Clients on Antiretroviral Therapy in Public Hospitals of Hawassa City Administration, Ethiopia. HIV AIDS (Auckl) 2022; 14:529-538. [PMID: 36425750 PMCID: PMC9680672 DOI: 10.2147/hiv.s387787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/11/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A majority of clients on first-line antiretroviral therapy with an initial high viral load will resuppress following an adherence intervention. Some sociodemographic and clinical characteristics were found to affect resuppression. Few reports on the outcome of the intervention and its associated factors in our country, with inconsistent results and some missed clinical factors of potential association, have compelled this study. The study aimed to assess the proportion of viral load suppression and associated factors among clients on antiretroviral therapy in public hospitals of Hawassa City Administration, Ethiopia. METHODS An institution-based cross-sectional study with retrospective document review was conducted among 342 participants on antiretroviral therapy enrolled for counseling since its start in November 2016. Data were captured using a pretested and structured checklist from all client charts with complete data, entered into EpiData 3.1.0 and exported to SPSS 27 for analysis. The proportion of viral load suppression was determined. Bivariate and multivariate logistic regressions were performed to identify associated factors. Statistical significance was determined at a 95% CI and P<0.05. RESULTS The proportion of viral load suppression was found to be 40.9% (35.7%-46.5%). Nevirapine-based antiretroviral treatment regimens (AOR 0.125, 95% CI 0.034-0.464), malnutrition (AOR 0.565, 95% CI 0.329-0.971), poor adherence (AOR 0.504, 95% CI 0.287-0.886), lower CD4 count (AOR 0.149, 95% CI 0.071, 0.314), and fewer counseling sessions (AOR 0.330, 95% CI 0.149-0.729) were significantly associated with viral load suppression. CONCLUSION The proportion of viral load suppression is lower than that recommended by the World Health Organization. Nevirapine-based regimens, poor nutritional status, poor adherence, lower CD4 count, and fewer counseling sessions risk a lower proportion of viral load suppression. This calls for the need to devise strategies to address these factors and to revisit program implementation.
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Affiliation(s)
| | | | - Eskinder Woticha
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Fithamlak Solomon
- School of Medical Laboratory, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Chanie ES, Muche AA, Gobeza MB, Alemu EM, Addis WD, Azanaw MM, Gebremariam AD, Tesfa D, Engidaw MT, Atikilit G, AbebawTiruneh S, Arage G. Half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children in Northwest Ethiopia; multi setting historical follow-up study. BMC Pediatr 2022; 22:114. [PMID: 35241036 PMCID: PMC8892785 DOI: 10.1186/s12887-022-03177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Even though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children. Methods A historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association. Results A total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years’ follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure. Conclusion In this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Mengistu Berhanu Gobeza
- Department of Paediatrics and Child Health Nursing, College of Medicine Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetie Molla Alemu
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wondimnew Desalegn Addis
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Desalegn Tesfa
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getaneh Atikilit
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sofonyas AbebawTiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Prendergast AJ, Szubert AJ, Pimundu G, Berejena C, Pala P, Shonhai A, Hunter P, Arrigoni FIF, Musiime V, Bwakura-Dangarembizi M, Musoke P, Poulsom H, Kihembo M, Munderi P, Gibb DM, Spyer MJ, Walker AS, Klein N. The impact of viraemia on inflammatory biomarkers and CD4+ cell subpopulations in HIV-infected children in sub-Saharan Africa. AIDS 2021; 35:1537-1548. [PMID: 34270487 PMCID: PMC7611315 DOI: 10.1097/qad.0000000000002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of virological control on inflammation and cluster of differentiation 4 depletion among HIV-infected children initiating antiretroviral therapy (ART) in sub-Saharan Africa. DESIGN Longitudinal cohort study. METHODS In a sub-study of the ARROW trial (ISRCTN24791884), we measured longitudinal HIV viral loads, inflammatory biomarkers (C-reactive protein, tumour necrosis factor alpha, interleukin 6 (IL-6), soluble CD14) and (Uganda only) whole blood immunophenotype by flow cytometry in 311 Zimbabwean and Ugandan children followed for median 3.5 years on first-line ART. We classified each viral load measurement as consistent suppression, blip/post-blip, persistent low-level viral load or rebound. We used multi-level models to estimate rates of increase or decrease in laboratory markers, and Poisson regression to estimate the incidence of clinical events. RESULTS Overall, 42% children experienced viral blips, but these had no significant impact on immune reconstitution or inflammation. Persistent detectable viraemia occurred in one-third of children and prevented further immune reconstitution, but had little impact on inflammatory biomarkers. Virological rebound to ≥5000 copies/ml was associated with arrested immune reconstitution, rising IL-6 and increased risk of clinical disease progression. CONCLUSIONS As viral load testing becomes more available in sub-Saharan Africa, repeat testing algorithms will be required to identify those with virological rebound, who need switching to prevent disease progression, whilst preventing unnecessary second-line regimen initiation in the majority of children with detectable viraemia who remain at low risk of disease progression.
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Affiliation(s)
| | | | | | | | - Pietro Pala
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | | | | | - Victor Musiime
- Joint Clinical Research Centre, Kampala, Uganda
- Makerere University College of Health Sciences
| | | | | | | | | | | | | | | | | | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health
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Outcomes of second-line antiretroviral therapy among children living with HIV: a global cohort analysis. J Int AIDS Soc 2020; 23:e25477. [PMID: 32297485 PMCID: PMC7160415 DOI: 10.1002/jia2.25477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Limited data describe outcomes on second-line antiretroviral therapy (ART) among children globally. Our objective was to contribute data on outcomes among children living with HIV after initiation of second-line ART in the context of routine care within a large global cohort collaboration. METHODS Patient-level data from 1993 through 2015 from 11 paediatric HIV cohorts were pooled. Characteristics at switch and through two years of follow-up were summarized for children who switched to second-line ART after starting a standard first-line regimen in North America, Latin America, Europe, Asia, Southern Africa (South Africa & Botswana) and the rest of sub-Saharan Africa (SSA). Cumulative incidences of mortality and loss to follow-up (LTFU) were estimated using a competing risks framework. RESULTS Of the 85,389 children on first-line ART, 3,555 (4%) switched to second-line after a median of 2.8 years on ART (IQR: 1.6, 4.7); 69% were from Southern Africa or SSA and 86% of second-line regimens were protease inhibitor-based. At switch, median age was 8.4 years and 50% had a prior AIDS diagnosis. Median follow-up after switch to second-line ranged from 1.8 years in SSA to 5.3 years in North America. Median CD4 counts at switch to second-line ranged from 235 cells/mm3 in SSA to 828 cells/mm3 in North America. Improvements in CD4 counts were observed over two years of follow-up, particularly in regions with lower CD4 counts at second-line switch. Improvements in weight-for-age z-scores were not observed during follow-up. Cumulative incidence of LTFU at two years was <5% in all regions except SSA (7.1%) and Southern Africa (7.4%). Risk of mortality was <3% at two years of follow-up in all regions, except Latin America (4.9%) and SSA (5.5%). CONCLUSIONS Children switched to second-line ART experience CD4 count increases as well as low to moderate rates of LTFU and mortality within two years after switch. Severe immune deficiency at time of switch in some settings suggests need for improved recognition and management of treatment failure in children.
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Ford N, Orrell C, Shubber Z, Apollo T, Vojnov L. HIV viral resuppression following an elevated viral load: a systematic review and meta-analysis. J Int AIDS Soc 2019; 22:e25415. [PMID: 31746541 PMCID: PMC6864498 DOI: 10.1002/jia2.25415] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Guidelines for antiretroviral therapy recommend enhanced adherence counselling be provided to individuals with an initial elevated viral load before making a decision whether to switch antiretroviral regimen. We undertook this systematic review to estimate the proportion of patients with an initial elevated viral load who resuppress following enhanced adherence counselling. METHODS Two databases and two conference abstract sites were searched from January 2012 to October 2019 for studies reporting the number of patients with an elevated viral load whose viral load was undetectable when subsequently assessed. Data were pooled using random effects meta-analysis. RESULTS Fifty-eight studies reported outcomes of 45,720 viraemic patients, mostly from Africa (48 studies), and among patients on first-line antiretroviral therapy (43 studies). Almost half (46.1%, 95% CI 42.6% to 49.5%) of patients with an initial elevated viral load resuppressed following an enhanced adherence intervention. Of those on first-line ART with confirmed virological failure (6280 patients, 21 studies), only 53.4% (40.1% to 66.8%) were appropriately switched to a different regimen. Resuppression was higher among studies that provided details of adherence support. The proportion resuppressing was lower among children (31.2%, 21.1% to 41.3%) and adolescents (40.4%, 15.7% to 65.2%) compared to adults (50.4%, 42.6% to 58.3%). No important differences were observed by date of study publication, gender, viral failure threshold, publication status, time between viral loads or treatment regimen. Information on resistance testing among people with an elevated viral load was inconsistently reported. CONCLUSIONS The findings of this review suggest that in settings with limited resources, current guideline recommendations to provide enhanced adherence counselling can result in resuppression of a substantial number of these patients, avoiding unnecessary drug regimen changes. Appropriate action on viral load results is limited across a range of settings, highlighting the importance of viral load cascade analyses to identify gaps and focus quality improvement to ensure that action is taken on the results of viral load testing.
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Affiliation(s)
- Nathan Ford
- Department of HIVWorld Health OrganizationGenevaSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Catherine Orrell
- Desmond Tutu HIV CentreInstitute of Infectious Disease and Molecular MedicineCape TownSouth Africa
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Zara Shubber
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
| | - Tsitsi Apollo
- Government of ZimbabweMinistry of Health and Child Care, AIDS and TB UnitHarareZimbabwe
| | - Lara Vojnov
- Department of HIVWorld Health OrganizationGenevaSwitzerland
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Innes S, Harvey J, Collins IJ, Cotton MF, Judd A. Lipoatrophy/lipohypertrophy outcomes after antiretroviral therapy switch in children in the UK/Ireland. PLoS One 2018; 13:e0194132. [PMID: 29617438 PMCID: PMC5884482 DOI: 10.1371/journal.pone.0194132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Following widespread use of stavudine, a thymidine analogue, in antiretroviral therapy (ART) over the past three decades, up to a third of children developed lipoatrophy (LA) and/or lipohypertrophy (LH). Following phasing-out of stavudine, incidence of newly-diagnosed LA and LH declined dramatically. However, the natural history of existing cases should be explored, particularly with prolonged protease inhibitor exposure. METHODS The Collaborative HIV Paediatric Study (CHIPS) is a multicentre cohort study of most HIV-infected children in the United Kingdom and Ireland. Those on ART with a LA/LH assessment recorded in 2003-2011 were included. Assessments were completed annually by consultant physicians. Using the 0-3 grading system, LA or LH was defined as grade 2 or 3. Resolution was defined as return to grade 1 or 0 in all body regions. RESULTS Of 1345 children followed for median (IQR) 5.5 (2.9, 8.2) years after ART initiation, 30 developed LA and 27 developed LH, all at least 2 years after ART initiation. Median age at LA diagnosis was 11 (10, 13) years and at LH diagnosis was 13 (11, 15) years. Children with LA were more likely white (p<0.0001); lower height-for-age z-score at ART initiation (p = 0.02); initiated ART earlier (p = 0.04), with longer ART exposure (p = 0.04). Children with LH were similar to those without. Analysis of individual drugs revealed that LA was associated with greater duration of exposure to stavudine and didanosine; while LH was associated with greater duration of exposure to stavudine and ritonavir (given alone or in combination with another protease inhibitor). Median time in follow-up following ART switch was 2.8 (1.9, 4.9) and 2.5 (1.6, 4.7) years respectively. Resolution occurred in 10 (30%) of LA cases (median time to resolution 2.3 [1.8, 3.6] years) and 3 (11%) of LH cases (median time to resolution 2.0 [1.7, 2.1] years). CONCLUSIONS Prevalence of LA and LH were low, with some resolution noted, especially for LA. More long-term data are needed.
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Affiliation(s)
- Steve Innes
- Family Infectious Diseases Clinical Research Unit (FAMCRU), Stellenbosch University, Cape Town, South Africa
- Department of Paediatrics and Child Health, Tygerberg Children’s Hospital and Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - Justin Harvey
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - Intira Jeannie Collins
- Medical Research Council Clinical Trials Unit at University College, London, United Kingdom
| | - Mark Fredric Cotton
- Family Infectious Diseases Clinical Research Unit (FAMCRU), Stellenbosch University, Cape Town, South Africa
- Department of Paediatrics and Child Health, Tygerberg Children’s Hospital and Stellenbosch University, Cape Town, South Africa
| | - Ali Judd
- Medical Research Council Clinical Trials Unit at University College, London, United Kingdom
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Sudjaritruk T, Aurpibul L, Ly PS, Le TPK, Bunupuradah T, Hansudewechakul R, Lumbiganon P, Chokephaibulkit K, Yusoff NKN, Van Nguyen L, Razali KAM, Fong MS, Nallusamy RA, Kurniati N, Do VC, Boettiger DC, Sohn AH, Kariminia A. Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy. J Adolesc Health 2017; 61:91-98. [PMID: 28343759 PMCID: PMC5483211 DOI: 10.1016/j.jadohealth.2017.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the incidence and predictors of postsuppression virologic rebound (VR) among adolescents on stable combination antiretroviral therapy in Asia. METHODS Perinatally HIV-infected Asian adolescents (10-19 years) with documented virologic suppression (two consecutive viral loads [VLs] <400 copies/mL ≥6 months apart) were included. Baseline was the date of the first VL <400 copies/mL at age ≥10 years or the 10th birthday for those with prior suppression. Cox proportional hazards models were used to identify predictors of postsuppression VR (VL >1,000 copies/mL). RESULTS Of 1,379 eligible adolescents, 47% were males. At baseline, 22% were receiving protease inhibitor-containing regimens; median CD4 cell count (interquartile range [IQR]) was 685 (448-937) cells/mm3; 2% had preadolescent virologic failure (VF) before subsequent suppression. During adolescence, 180 individuals (13%) experienced postsuppression VR at a rate of 3.4 (95% confidence interval: 2.9-3.9) per 100 person-years, which was consistent over time. Median time to VR during adolescence (IQR) was 3.3 (2.1-4.8) years. Wasting (weight-for-age z-score <-2.5), being raised by grandparents, receiving second-line protease inhibitor-based regimens, starting combination antiretroviral therapy after 2005, and having preadolescent VF were independent predictors of adolescent VR. At VR, median age, CD4 cell count, and VL (IQR) were 14.8 (13.2-16.4) years, 507 (325-723) cells/mm3, and 4.1 (3.5-4.7) log10 copies/mL, respectively. CONCLUSIONS A modest and consistent incidence of postsuppression VR was documented during adolescence in our cohort. Having poor weight, receiving second-line regimens, and prior VF were associated with an increased VR rate. Adolescents at higher risk of VR may benefit from more intensive VL monitoring to enhance adherence management.
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Affiliation(s)
- Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | | | | | | | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Annette H. Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research, Bangkok, Thailand
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First-Line Antiretroviral Treatment Outcomes and Durability in HIV-Infected Children Treated Through the Universal Coverage Health Program in Thailand. J Acquir Immune Defic Syndr 2017; 75:219-225. [PMID: 28498146 DOI: 10.1097/qai.0000000000001351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We assessed the treatment outcomes on first-line antiretroviral therapy (ART), and factors associated with switching regimen in HIV-infected children treated through the universal coverage health program (UC) in Thailand. METHODS Children aged <15 years at ART initiation who had been receiving ART for at least 6 months between 2008 and 2014 through UC were included in the analysis. The Kaplan-Meier method was used to estimate immunological recovery (IMR), immunological failure, and virological failure (VF). Cox models were used to assess predictors of IMR and VF. Competing risk models were used to assess factors associated with switching to a second-line regimen, with death considered as a competing risk. RESULTS A total of 4120 children initiated ART at a median (interquartile range) age of 9.3 (5.8-12.0) years. The median duration of ART was 3.7 years with 17,950 person-years of follow-up. Two thousand eight hundred five children achieved IMR, and the probability of IMR increased to 76% by 3 years after ART initiation. Among 1054 children switched to second-line regimens, 84% had VF and 19% had immunological failure. The cumulative rate of switching regimen increased from 4% to 20% from 1 to 3 years after treatment. Children aged ≥12 years at ART initiation, starting with nonnucleoside reverse-transcriptase inhibitors, and baseline CD4% <10% had an increased risk of switching to second-line regimens. CONCLUSIONS Children receiving ART through UC had good treatment outcomes, although a fifth required switching regimen by 3 years. Earlier treatment initiation and avoiding nonnucleoside reverse-transcriptase inhibitor first-line regimens in high-risk children may prevent treatment failure.
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Rojas Sánchez P, Prieto L, Jiménez De Ory S, Fernández Cooke E, Navarro ML, Ramos JT, Holguín Á. Impact of lopinavir-ritonavir exposure in HIV-1 infected children and adolescents in Madrid, Spain during 2000-2014. PLoS One 2017; 12:e0173168. [PMID: 28350802 PMCID: PMC5369685 DOI: 10.1371/journal.pone.0173168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 02/16/2017] [Indexed: 01/18/2023] Open
Abstract
Background The most-used protease-inhibitor in children is Lopinavir-ritonavir (LPV/r), which provides durable suppression of viral load and increases CD4+T-counts. This study describes the virological outcome of the HIV-1-infected paediatric population exposed to LPV/r during 15 years in Spain. Methodology Patients from the Madrid Cohort of HIV-1-infected-children and adolescents exposed to LPV/r as different line therapy during 2000–2014 were selected. The baseline epidemiological-clinical features, viral suppression, changes in CD4+T-CD8+T cell counts and drug susceptibility were recorded before and during LPV/r exposure. Drug resistance mutations (DRM) were identified in viruses from samples collected until 2011. We predicted drug susceptibility to 19 antiretrovirals among those carrying DRM using the Stanford′s HIVdb Algorithm. Results A total of 199 (37.3%) of the 534 patients from the cohort were exposed to LPV/r during 2000–2014 in first (group 1), second (group 2) or more line-therapies (group 3). Patients were mainly Spaniards (81.9%), perinatally infected (96.5%) with subtype-B (65.3%) and HIV-diagnosed before year 2000 (67.8%). The mean age at first LPV/r exposure was 9.7 years. After protease-inhibitor exposure, viral suppression was higher in groups 1 and 2 than in group 3. Viral suppression occurred in 87.5%, 68.6% and 64.8% patients from groups 1, 2 and 3, respectively. Among the 64 patients with available resistance data during LPV/r treatment, 27(42.3%) carried DRM to protease-inhibitor, 28 (58.3%) to reverse-transcriptase-inhibitors and 21 (43.7%) to non-reverse-transcriptase-inhibitors. Darunavir/ritonavir, atazanavir-ritonavir and tipranavir/ritonavir presented the highest susceptibility and nelfinavir the lowest. Conclusions A better lymphocyte recovering occurred when protease-inhibitor was taken as part of a first-line regimen and a higher number of patients reached viral suppression. The least compromised antiretrovirals for rescue antiretroviral regimens, according to DRM in the LPV/r-exposed-paediatric cohort, were mainly the new protease inhibitors.
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Affiliation(s)
- Patricia Rojas Sánchez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital RamÓn y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
| | - Luis Prieto
- Infectious Diseases Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Santiago Jiménez De Ory
- Molecular Inmuno-Biology Laboratory, Hospital Universitario Gregorio Marañón-IISGM and CIBER-BBN, Madrid, Spain
| | - Elisa Fernández Cooke
- Infectious Diseases Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Maria Luisa Navarro
- Infectious Diseases Unit, Paediatric Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Tomas Ramos
- Infectious Diseases Department, Hospital Clínico Universitario and Universidad Complutense, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital RamÓn y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
- * E-mail:
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11
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Nlend AEN, Lyeb S, Moyo STN, Motaze AN. Viral Monitoring and Prevalence of Viral Failure in HIV-1 Infected Children under First Line Antiretroviral Therapy during the First 60 Months of Treatment in Yaoundé, Cameroon: A Serial Cross Sectional Analysis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojped.2016.61012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Cotton MF, Rabie H. Maintenance of antiretroviral efficacy in children. Lancet HIV 2015; 2:e120-e121. [PMID: 26424670 DOI: 10.1016/s2352-3018(15)00040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/03/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Mark F Cotton
- Children's Infectious Diseases Clinical Research Unit and Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Helena Rabie
- Children's Infectious Diseases Clinical Research Unit and Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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