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Machila N, Libonda L, Habineza P, Velu RM, Kamboyi HK, Ndhlovu J, Wamunyima I, Sinadambwe MM, Mudenda S, Zyambo C, Bumbangi FN. Prevalence and predictors of virological failure in pediatric patients on HAART in sub-Saharan Africa: a systematic review and meta-analysis. Pan Afr Med J 2023; 45:98. [PMID: 37692980 PMCID: PMC10491719 DOI: 10.11604/pamj.2023.45.98.37017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/08/2023] [Indexed: 09/12/2023] Open
Abstract
Antiretroviral treatment failure has emerged as a challenge in the management of pediatric human immunodeficiency virus (HIV) patients, especially in resource-limited countries despite accessibility to Highly Active Antiretroviral Therapy (HAART). A systematic review and meta-analysis was conducted to synthesize virological failure (VF) prevalence and ascertain its predictors in children in sub-Saharan Africa. An electronic database search strategy was conducted from January to September 2021 on PubMed, EMBASE, SCOPUS, HINARI, and CINAHL. Further, manual searching was conducted on non-indexed journals. Utilizing the JASP© version 0.17.2 (2023) statistical software, a meta-analysis of pooled prevalence of VF was estimated using the standardized mean differences. Further, selection models were used to assess the risk of bias and heterogeneity. The pooled odds ratios were estimated for the respective studies reporting on predictors of VF. The overall pooled estimate of the prevalence of VF in sub-Saharan Africa among the sampled population was 29% (95% CI: 27.0-32.0; p<0.001). Predictors of VF were drug resistance (OR: 1.68; 95% CI: 0.88-2.49; p < 0.001), poor adherence (OR: 5.35; 95% CI: 5.26-5.45; p < 0.001), nevirapine (NVP)-based regimen (OR: 5.11; 95% CI: 4.66-5.56; p < 0.001), non-usage of cotrimoxazole prophylaxis (OR: 4.30; 95% CI: 4.13-4.47; p < 0.001), higher viral load at the initiation of antiretroviral therapy (ART) (OR: 244.32; 95% CI: 244.2-244.47; p <0.001), exposure to the prevention of mother to child transmission (PMTCT) (OR: 8.02; 95%CI: 7.58-8.46; p < 0.001), increased age/older age (OR: 3.37; 95% CI: 2.70-4.04; p < 0.001), advanced World Health Organization (WHO) stage (OR: 6.57; 95% CI: 6.17-6.98; p < 0.001), not having both parents as primary caregivers (OR: 3.01; 95% CI: 2.50-3.53; p < 0.001), and tuberclosis (TB) treatment (OR: 4.22; 95% CI: 3.68-4.76; p <0.001). The mean VF prevalence documented is at variance with studies in other developing countries outside the sub-Saharan region. The high prevalence of HIV cases contrasting with the limited expertise in the management of pediatric ART patients could explain this variance.
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Affiliation(s)
- Nchimunya Machila
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | - Liyali Libonda
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | - Paul Habineza
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | | | - Harvey Kakoma Kamboyi
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
- Division of Infection and Immunity, International Institute for Zoonosis Control, Hokkaido University, Hokkaido, Japan
| | - Jacob Ndhlovu
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | - Inonge Wamunyima
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | | | - Steward Mudenda
- Department of Pharmacy, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Cosmas Zyambo
- Department of Community and Family Health, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
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Getaneh Y, Ning F, He Q, Rashid A, Kassa D, Assefa Y, Yi F, Liao L, Shao Y. Survival and Predictors of Mortality among Adults Initiating Highly Active Antiretroviral Therapy in Ethiopia: A Retrospective Cohort Study (2007-2019). BIOMED RESEARCH INTERNATIONAL 2022; 2022:5884845. [PMID: 36467882 PMCID: PMC9711997 DOI: 10.1155/2022/5884845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/22/2022] [Accepted: 11/11/2022] [Indexed: 10/14/2023]
Abstract
Background Studies have shown high early mortality after initiation of highly active antiretroviral therapy (HAART). We examined change in three-year survival and predictors of mortality of patients initiating HAART in Ethiopia since 2007 to 2019. Methods A retrospective cohort study was conducted in 47 health facilities (HFs) using records of 11,013 adult patients initiating HAART from 2007 to 2019. Study subjects were stratified as four different cohorts based on their calendar year of HAART initiation: 2007-2010, 2011-2013, 2014-2016, and 2017-2019. HFs were selected using probability proportional to size of patients. Survival rate and predictors of mortality were estimated by the calendar year using the Kaplan-Meier and Cox proportional hazard, respectively. We generated a pooled estimate of survival rate and predicators of mortality. Results Data from 1881, 3868, 3004, and 2260 patients were retrieved from each of the cohorts. Overall mortality for all cohorts at all times was 10.3%. A gradual decline of mortality was observed in the first three years of follow-up since 2007-2016 which were 21.37%, 10.03%, and 4.34% among patients who initiated HAART in 2007, 2011, and 2014 respectively. A mortality jump of 9.25% was observed among patents initiating HAART in 2017, which coincided with political instability happened in the country. Of the 21,638 person-years of follow-up among 11,013 adults, mortality was 5.23/100 person-years, while disaggregated by the cohorts, it was 14.77, 5.06, 2.12, and 4.17 per 100 person-years, respectively. Among all the cohorts, patients with CD4 count of ≤200 cells/mm3, unsuppressed viral load, poor adherence, and drug resistance in all cohorts, respectively, have overall 2.0 (95%CI = 1.35 - 2.69), 4.66 (95%CI = 2.53 - 6.72), 6.78 (95%CI = 3.4 - 10.3), and 10.02 (95%CI = 6.91 - 13.82) times of mortality risk than those without. Patients with bedridden for cohort initiating HAART during 2007 and 2011 were 2.0 (95%CI = 1.35 - 2.69) times of mortality risk than those without. Conclusion Patients initiating HAART from 2007 to 2016 have continuously improved their survival during three-year cohort follow-up in Ethiopia. The significant decline of survival among those who initiate HAART as of 2017 calls for program intervention. Low CD4 counts, unsuppressed viral load, poor adherence, and drug resistance could be used as predictors for increased mortality to monitor the quality of HAART and improve clinical management of HIV/AIDS patients.
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Affiliation(s)
- Yimam Getaneh
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Feng Ning
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Qianxin He
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Abdur Rashid
- School of Medicine, Nankai University, Tianjin, China
| | - Desta Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- University of Queensland, School of Public Health, Queensland, Australia
| | - Feng Yi
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Lingjie Liao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yiming Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
- Changping Laboratory, Beijing, China
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Njom-Nlend AE, Efouba N, Brunelle Sandie A, Fokam J. Determinants of switch to paediatric second-line antiretroviral therapy after first-line failure in Cameroon. Trop Med Int Health 2021; 26:927-935. [PMID: 33905593 DOI: 10.1111/tmi.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE With scale-up of antiretroviral therapy (ART) children, treatment failure and switch to subsequent ART regimens are common. Our objectives were to evaluate switching practices and identify factors associated among children and adolescents failing their first-line ART. METHODS A facility-based survey study was conducted in a cohort of children living with HIV experiencing virological failure (VF) at the Essos Hospital Centre of Yaounde, Cameroon. Data were collected using a standard questionnaire, and key variables were as follows: (a) VF defined as viral load (VL) > 1000 copies/ml, (b) rate of switch to second-line and (c) reason(s) for switching ART. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the association between study variables, and P < 0.05 was considered statistically significant. RESULTS A total of 106 children experiencing VF were enrolled: median age was 8 [interquartile range (IQR): 3-15] years; 60.38% were boys and 39.62% were orphans of one/both parents. A proportion of 69% were at the WHO clinical stage III/IV, and 13.21% were experiencing immunological failure (CD4 < 200 cells/mm3 ). The median duration on first-line ART was 36 [IQR: 7-157] months prior to detecting VF, and the rate of switch to second-line ART was 70.75% (75/106). Delay in switching ART after a confirmed VF was 11 [IQR: 7-16] months. After switch to second-line ART, the median time to achieve undetectable VL (<40 copies/ml) was 14 [IQR: 9-21] months. Multivariate analysis revealed that only children with viral rebound (aOR = 0.09; 95% CI = 0.03-0.24) were less likely to be switched. Of note, being orphaned (aOR = 0.35, CI = 0.11-1.11), biological sex (aOR = 1.77, CI = 0.60-5.29) and immune status (aOR = 0.19, CI = 0.03-1.31, 0.09) had no significant effect on switching to second-line ART. CONCLUSION In this paediatric population experiencing VF after about 3-4 years from ART initiation, the majority are switched to second-line ART after a delay of almost one year. Delayed switch to second-line was driven essentially by viral rebound, underscoring the need for close viral monitoring.
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Affiliation(s)
- Anne-Esther Njom-Nlend
- Essos Hospital Centre, National Social Insurance Fund Hospital, Yaoundé, Cameroon.,Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
| | - Nadège Efouba
- Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
| | | | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaounde, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,National HIV Drug Resistance Working Group, Ministry of Public Health, Yaounde, Cameroon
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Ekpenyong ME, Etebong PI, Jackson TC. Fuzzy-multidimensional deep learning for efficient prediction of patient response to antiretroviral therapy. Heliyon 2019; 5:e02080. [PMID: 31372545 PMCID: PMC6656963 DOI: 10.1016/j.heliyon.2019.e02080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 01/09/2023] Open
Abstract
Drug component interactions are most likely to trigger unexpected pharmacological effects with unknown causal mechanisms, hence, demanding the discovery of patterns to establish suitable and effective regimens. This paper proposes a novel framework that embeds machine learning (ML) and multidimensional scaling (MDS) techniques, for efficient prediction of patient response to antiretroviral therapy (ART). To achieve this, experiment databases were created from two independent sources: a publicly available HIV domain datasets of patients with failed treatment – hosted by the Stanford University, hereinafter referred to as the Stanford HIV database, and locally sourced datasets gathered from 13 prominent healthcare facilities treating HIV patients in Akwa Ibom State of Nigeria, hereinafter referred to as the Akwa-Ibom HIV database: with 5,780 and 3,168 individual treatment change episodes (TCEs) of HIV treatment indicators (baseline CD4 count (BCD4), followup CD4 count (FCD4), baseline viral load (BRNA), followup viral load (FRNA), and drug type combination (DType)), observed from 1,521 and 1,301 unique patient records, respectively. A hybridised (two-stage) classification system consuming the Interval Type-2 Fuzzy Logic (IT2FL) and Deep Neural Network (DNN) was employed to model and optimise patients’ response to ART with appreciable error pruning achieved through MDS. Visualisation of the experiment databases showed remarkable immunological changes in the Akwa-Ibom HIV database, as the FCD4 of TCEs clustered far above the BCD4, compared to the Stanford HIV database, where over 40% of FCD4 clustered below the BCD4. Similar changes were noticed for the RNA, as more FRNA copies clustered below the BRNA for the Akwa-Ibom datasets, compared to the Stamford datasets. DNN classification results for both databases showed best performance metrics for the Levenberg-Marquardt algorithm when compared with the resilient backpropagation algorithm, with improved drug pattern predictions for experiment with MDS. This paper is most likely to evolve an avenue that triggers interesting combination(s) for optimum patient response, while ensuring minimal side effects, as further findings revealed the superiority of the proposed approach over existing approaches.
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Kaung Nyunt KK, Han WW, Satyanarayana S, Isaakidis P, Hone S, Khaing AA, Nguyen Binh H, Oo HN. Factors associated with death and loss to follow-up in children on antiretroviral care in Mingalardon Specialist Hospital, Myanmar, 2006-2016. PLoS One 2018; 13:e0195435. [PMID: 29621302 PMCID: PMC5886568 DOI: 10.1371/journal.pone.0195435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 03/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background Myanmar National AIDS programme’s priority is to improve the survival of all people living with HIV by providing anti-retroviral therapy (ART) care. More than 7200 children (aged <15 years) have been enrolled into ART care from 2005 to 2016. A previous study showed that ~11% children on ART care had either died or were lost to follow-up by 60 months. Factors associated with death and lost-to follow-up (adverse outcomes) have not been previously studied. Objectives To describe the association between demographic and clinical characteristics at enrollment into ART care with adverse outcomes. Methods Cohort study using records of children enrolled for ART care at Mingalardon Specialist Hospital (main Paediatric ART center in Myanmar) from 2006–2016. We used multivariable Cox proportional hazards regression models for analysis. Results 1,159 children were enrolled for ART care and they contributed a total of 1.45 million person-days of follow-up period. 112 (10%) had an adverse outcome during the follow-up time period (55 deaths, 57 lost to follow-up). Enrollment into the ART care through in-patient care department of the hospital, CD4 Cell count <50/mm3, enrollment during changing ART guidelines (different ART eligibility criteria and preferred ART regimen) were independently associated with higher hazards of adverse outcome. Receiving protease inhibitor-based ART regimen at enrollment was independently associated with lower hazards of adverse outcome. Age, sex, residing in urban or rural areas, WHO clinical stage, having TB at the time of enrollment, receiving cotrimoxazole prophylaxis were not statistically associated with adverse outcomes. Conclusion Our analysis reconfirms good survival of children on ART care (including those with TB). The characteristics associated with adverse outcomes (other than CD4 cell count<50) are surrogates of some unmeasured underlying health system/ patient related factors that needs further exploration to improve the survival of children on ART care.
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Affiliation(s)
- Kay Khaing Kaung Nyunt
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
- * E-mail:
| | - Wai Wai Han
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Srinath Satyanarayana
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Petros Isaakidis
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai, India
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Operational Research Unit, Luxembourg
| | - San Hone
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aye Aye Khaing
- Mingaladon Specialist Hospital, Department of Medical Care, Ministry of Health and Sports, Yangon, Myanmar
| | - Hoa Nguyen Binh
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- National Tuberculosis Program Vietnam, Hanoi, Viet Nam
| | - Htun Nyunt Oo
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Jha UM, Dhingra N, Raj Y, Rewari BB, Jeyaseelan L, Harvey P, Chavan L, Saggurti N, Reddy DCS. Survival of Children Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Andhra Pradesh, India. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ségéral O, Nerrienet E, Neth S, Spire B, Khol V, Ferradini L, Sarun S, Mom C, Ngin S, Charpentier C, Men P, Mora M, Mean Chhi V, Ly P, Saphonn V. Positive Virological Outcomes of HIV-Infected Patients on Protease Inhibitor-Based Second-Line Regimen in Cambodia: The ANRS 12276 2PICAM Study. Front Public Health 2018; 6:63. [PMID: 29662875 PMCID: PMC5890147 DOI: 10.3389/fpubh.2018.00063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background Assessment of virological outcomes among HIV-infected patients receiving protease (PR) inhibitor-based second-line regimen are uncommon in Cambodia. The objective of this study is to assess the virological effectiveness of this regimen as well as impact of adherence boosting for patients experiencing virological failure. Methods The 2PICAM study (Clinicaltrial: NCT01801618) is a cross-sectional study of HIV-infected adults on PR inhibitor-based second-line regimen since at least 6 months, conducted in 13 representative sites, comprising more than 90% of the target population. Adults with HIV RNA above 250 copies/mL (threshold of the assay) at inclusion received boosted adherence counseling during 3 months followed by HIV RNA control. For confirmed virological failure, genotype resistance test was performed and expert committee used results for therapeutic decision. Results Among the 1,317 adults enrolled, the median duration of second-line regimen was 5 years. At inclusion, 1,182 (89.7%) patients achieved virological success (<250 copies/mL) and 135 (10.3%) experienced a virological failure (>250 copies/mL). In multivariable analysis, factors associated with virological success were: CD4 cell count between 201 and 350/mm3 (OR: 4.66, 95% CI: 2.57–8.47, p < 0.0001) and >350/mm3 (OR: 6.67, 95% CI: 4.02–11.06, p < 0.0001), duration of PI-based regimen >2 years (OR: 1.64, 95% CI: 1.03–2.62, p = 0.037), ATV-containing regimen (0R: 1.65, 95% CI: 1.04–2.63, p = 0.034) and high level of adherence (OR: 2.41, 95% CI: 1.07–5.41, p = 0.033). After adherence counseling, 63 (46.7%) patients were rescued while 72 (53.3%) were not. For the 54 patients with genotype resistance tests available, high or intermediate levels of resistance to lopinavir, atazanavir, and darunavir were reported for 13 (24%), 12 (22.2%), and 2 (3.7%) patients, respectively. Change to an alternative PR inhibitor-based regimen was recommended for 17 patients and to third-line regimen, including integrase inhibitors for 12. Conclusion This study reports high rate of virological suppression of second-line regimen and importance of adherence boosting prior to deciding any change of ART regimen. Genotype resistance tests appear necessary to guide decisions. Such information was of great importance for National HIV Program to adapt guidelines and program needs for third-line regimen.
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Affiliation(s)
- Olivier Ségéral
- French Agency for Research on AIDS and Viral Hepatitis (ANRS), Paris, France.,University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Eric Nerrienet
- Institut Pasteur, Paris, France.,France Expertise Internationale, Paris, France
| | - Sansothy Neth
- University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
| | | | - Saramony Sarun
- University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Chandara Mom
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
| | - Sopheak Ngin
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
| | - Charlotte Charpentier
- INSERM, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Bichat, Laboratoire de Virologie, Paris, France
| | | | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Vun Mean Chhi
- University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Penhsun Ly
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
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Predictors of Virologic Failure on First-line Antiretroviral Therapy Among Children in a Referral Pediatric Center in Cameroon. Pediatr Infect Dis J 2017; 36:1067-1072. [PMID: 28661967 DOI: 10.1097/inf.0000000000001672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suboptimal response to antiretroviral therapy (ART) is common among children living with HIV (CLHIV) in resource-limited settings. We sought to assess virologic failure (VF), time for switching to second-line regimens and factors associated with VF in CLHIV receiving first-line ART in Cameroon. METHODS An observational cohort study was conducted in 375 CLHIV initiating a first-line ART and treated for ≥6 months at the National Social Insurance Fund Hospital in Yaoundé-Cameroon from 2009 to 2013. Using logistic regression, predictors of VF and delayed switch were assessed by univariate and multivariate analysis. P < 0.05 was considered statistically significant. RESULTS Overall, 17% (64/375) CLHIV experienced VF on first-line ART after a median time of 28 (interquartile range: 22-38) months. After VF, median time to switching from first- to second-line ART was 20 (interquartile range: 8-24) months. In multivariate analysis, VF was associated with male gender (adjusted odds ratio: 0.36; 95% confidence interval: 0.19-0.71; P = 0.003), motherless children (adjusted odds ratio: 2.9; 95% confidence interval: 1.3-6.06; P = 0.005) and treatment with stavudine-containing compared with zidovudine-containing regimens (P = 0.022). Overall, male gender, orphanhood (motherless) and treatment with stavudine-containing regimens predicted VF at a rate of 70% (area under curve =0.70). CONCLUSION VF on first-line pediatric ART is common, and switching children failing first-line to second-line ART is considerably delayed. These results suggest performance of pediatric ART program can be improved by targeting orphans, adapting counseling for male children, complete phasing-out of stavudine and ensuring timely switch to second-line regimens.
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Ben-Farhat J, Schramm B, Nicolay N, Wanjala S, Szumilin E, Balkan S, Pujades-Rodríguez M. Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001-2010. Trop Med Int Health 2017; 22:340-350. [PMID: 27992677 DOI: 10.1111/tmi.12830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess mortality and clinical outcomes in children treated with antiretroviral therapy (ART) in four African vertical programmes between 2001 and 2010. METHODS Cohort analysis of data from HIV-infected children (<15 years old) initiating ART in four sub-Saharan HIV programmes in Kenya, Uganda and Malawi, between December 2001 and December 2010. Rates of mortality, programme attrition and first-line clinico-immunological failure were calculated by age group (<2, 2-4 and 5-14 years), 1 or 2 years after ART initiation, and risk factors were examined. RESULTS A total of 3949 children, 22.7% aged <2 years, 32.2% 2-4 years and 45.1% 5-14 years, were included. At ART initiation, 60.8% had clinical stage 3 or 4, and 46.5% severe immunosuppression. Overall mortality, attrition and 1-year failure rates were 5.1, 10.8 and 9.0 per 100 person-years, respectively. Immunosuppression, stage 3 or 4, and underweight were associated with increased rates of mortality, attrition and treatment failure. Adjusted estimates showed lower mortality hazard ratios (HR) among children aged 2-4 years (HR = 0.57, 95% CI 0.42-0.77 than children aged 5-14 years). One-year treatment failure incidence rate ratios (IRR) were similar regardless of age (IRR = 0.91, 95% CI 0.67-1.25 for <2 years; 1.01, 95% CI 0.83-1.23 for 2-4 years, vs. 5-14 years). CONCLUSIONS Good treatment outcomes were achieved during the first decade of HIV paediatric care despite the late start of therapy. Encouraging early HIV infant diagnosis in and outside prevention of mother-to-child transmission programmes, and linkage to care services for early ART initiation, is needed to reduce mortality and delay treatment failure.
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Affiliation(s)
| | | | | | | | | | | | - Mar Pujades-Rodríguez
- Epicentre, Paris, France.,MRC Medical Bioinformatics Centre, University of Leeds, Leeds, UK
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Retention of HIV-Infected Children in the First 12 Months of Anti-Retroviral Therapy and Predictors of Attrition in Resource Limited Settings: A Systematic Review. PLoS One 2016; 11:e0156506. [PMID: 27280404 PMCID: PMC4900559 DOI: 10.1371/journal.pone.0156506] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/16/2016] [Indexed: 02/06/2023] Open
Abstract
Current UNAIDS goals aimed to end the AIDS epidemic set out to ensure that 90% of all people living with HIV know their status, 90% initiate and continue life-long anti-retroviral therapy (ART), and 90% achieve viral load suppression. In 2014 there were an estimated 2.6 million children under 15 years of age living with HIV, of which only one-third were receiving ART. Little literature exists describing retention of HIV-infected children in the first year on ART. We conducted a systematic search for English language publications reporting on retention of children with median age at ART initiation less than ten years in resource limited settings. The proportion of children retained in care on ART and predictors of attrition were identified. Twelve studies documented retention at one year ranging from 71–95% amongst 31877 African children. Among the 5558 children not retained, 4082 (73%) were reported as lost to follow up (LFU) and 1476 (27%) were confirmed to have died. No studies confirmed the outcomes of children LFU. Predictors of attrition included younger age, shorter duration of time on ART, and severe immunosuppression. In conclusion, significant attrition occurs in children in the first 12 months after ART initiation, the majority attributed to LFU, although true outcomes of children labeled as LFU are unknown. Focused efforts to ensure retention and minimize early mortality are needed as universal ART for children is scaled up.
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Barennes H, Virak K, Rouet F, Buisson Y, Strobel M, Vibol U. Factors associated with the failure of first and second-line antiretroviral therapies therapy, a case control study in Cambodian HIV-1 infected children. BMC Res Notes 2016; 9:69. [PMID: 26850410 PMCID: PMC4744409 DOI: 10.1186/s13104-016-1884-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/22/2016] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about the efficacy of first and and second-line antiretroviral therapies (ART) for HIV-1 infected children in resource limited Southeast Asian settings. Previous studies have shown that orphans are at a higher risk for virological failure (VF) in Cambodia. Consequently most of them required transfer to second-line ART. We assessed the factors associated with VF among HIV-1 infected children who were either under first-line (mostly 3TC + D4T + NVP) or under second-line (mostly ABC + DDI + LPV) therapies at a referral hospital in Cambodia. Methods A case-control study was conducted from February to July 2013 at the National Pediatric Hospital among HIV-1 infected children (aged 1–15 years) under second-line ART (cases) or first-line (matched controls at a ratio of 1:3) regimens. Children were included if a HIV-1 RNA plasma viral load (VL) result was available for the preceding 12 months. A standardized questionnaire explored family sociodemographics, HIV history, and adherence to ART. Associations between VF (HIV-1 RNA levels ≥1000 copies/ml) and the children’s characteristics were assessed using bivariate and multivariate analyses. Results A total of 232 children, 175 (75.4 %) under first-line and 57 (24.6 %) under second-line ART, for a median of 72.0 (IQR: 68.0–76.0) months, were enrolled. Of them, 94 (40.5 %) were double orphans and 51 (22.0 %) single orphans, and 77 (33.2 %) were living in orphanages. A total of 222 children (95.6 %) were deemed adherent to ART. Overall, 18 (7.7 %; 95 % CI 4.6–11.9) showed a VF, 14 (8.6 %; 95 % CI 4.8–14.0) under first-line and 4 (7.0 %; 95 % CI 1.9–17.0) under second-line ART (p = 0.5). Their median CD4 percentage was 8 % (IQR 2.9–12.9) at ART initiation. Children under second-line ART were older; more often double orphans, and had lower CD4 cell counts at the last control. In the multivariate analysis, having the last CD4 percentage below 15 % was the only factor associated with VF for ART regimen separately or when combined (OR 40.4; 95 % CI 11–134). Conclusions The pattern of risk factors for VF in children is changing in Cambodia. Improved adherence evaluation and intensified monitoring of children with low CD4 counts is needed to decrease the risk of VF. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-1884-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hubert Barennes
- Agence Nationale de Recherche sur le VIH et les Hépatites, Preah Monyvong Blvd, Phnom Penh, Cambodia. .,Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao People's Democratic Republic. .,ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, 33000, Bordeaux, France. .,Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia.
| | - Kang Virak
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao People's Democratic Republic.
| | - François Rouet
- Virological Unit, Pasteur Institute, Phnom Penh, Cambodia.
| | - Yves Buisson
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao People's Democratic Republic.
| | - Michel Strobel
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao People's Democratic Republic.
| | - Ung Vibol
- University of Health Science, Phnom Penh, Cambodia.
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Abdollahi A, Saffar H. The Diagnosis of HIV Infection in Infants and Children. IRANIAN JOURNAL OF PATHOLOGY 2016; 11:89-96. [PMID: 27499768 PMCID: PMC4939637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/30/2015] [Indexed: 06/06/2023]
Abstract
It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started anti-retroviral therapy (ART) as early as possible after diagnosis of HI. Early confirmation of HIV diagnosis is required in order to identify infants who need immediate ART. WHO has designed recommendations to improve programs for both early diagnoses of HIV infection and considering ART whenever indicated? It is strongly recommended that HIV virologocal assays for diagnosis of HIV have sensitivity of at least 95% and ideally greater than 98% and specificity of 98% or more under standardized and validated conditions. Timing of virological testing is also important. Infants infected at or around delivery may take short time to have detectable virus. Therefore, sensitivity of virological tests is lower at birth. In utero HIV infection, HIV DNA or RNA can be detected within 48 h of birth and in infants with peripartum acquisition it needs one to two weeks. Finally it is emphasized that all laboratories performing HIV tests should follow available services provided by WHO or CDC for quality assurance programs. Both clinicians and staffs providing laboratory services need regular communications, well-defined SOPs and nationally validated algorithms for optimal use of laboratory tests. Every country should use assays that have been validated by national reference laboratory.
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Affiliation(s)
- Alireza Abdollahi
- Dept. of Pathology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Thrombosis Homeostasis Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hana Saffar
- Dept. of Pathology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Implementation and Operational Research: High Loss to Follow-up Among Children on Pre-ART Care Under National AIDS Program in Madurai, South India. J Acquir Immune Defic Syndr 2015; 69:e109-14. [PMID: 26181709 DOI: 10.1097/qai.0000000000000640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Information on the follow-up of HIV-infected children enrolled into preantiretroviral therapy (Pre-ART) care under routine program settings is limited in India. Knowledge on the magnitude of loss to follow-up (LFU) and its reasons will help programs to retain children in HIV care. We aimed to assess the proportion of LFU among children in Pre-ART care and its associated factors. METHODS In this retrospective cohort study, we reviewed the records of all HIV-infected children (aged <15 years) registered from 2005 to 2012 at an ART center, Madurai, South India. LFU during Pre-ART care was defined as having not visited the ART center within a year of registration. RESULTS Of 426 children enrolled in Pre-ART care, 211 (49%) were females and 301 (71%) were in the 5- to 14-year age group. At 1 year of registration, 348 (82%) were lost to follow-up. Of 348, 81 returned to care after 1 year of enrollment, whereas 267 (63% of all children) were permanently lost to follow-up. The proportion of LFU remained high from 2005 to 2012. WHO staging, CD4 count, and opportunistic infection were the significant factors associated with lost to follow-up on multivariate analysis. CONCLUSIONS LFU was alarmingly high indicating poor clinical and programmatic monitoring among HIV-infected children enrolled in Pre-ART care. A system for active tracing of those missing a clinic appointment intensified supervision, and monitoring along with qualitative research is urgently needed. This will help to understand the exact reasons for LFU based on which effective interventions may be planned for reducing such losses.
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McGrath CJ, Diener L, Richardson BA, Peacock-Chambers E, John-Stewart GC. Growth reconstitution following antiretroviral therapy and nutritional supplementation: systematic review and meta-analysis. AIDS 2015; 29:2009-23. [PMID: 26355573 PMCID: PMC4579534 DOI: 10.1097/qad.0000000000000783] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As antiretroviral therapy (ART) expands for HIV-infected children, it is important to determine its impact on growth. We quantified growth and its determinants following ART in resource-limited (RLS) and developed settings. DESIGN Systematic review and meta-analysis. METHODS We searched publications reporting growth [weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) z scores] in HIV-infected children following ART through August 2014. Inclusion criteria were as follows: younger than 18 years; ART; at least 20 patients; growth at ART; and post-ART growth. Standardized and overall weighted mean differences were calculated using random-effects models. RESULTS A total of 67 articles were eligible (RLS = 54; developed settings = 13). Mean age was 5.8 years, and comparable between settings (P = 0.90). Baseline growth was substantially lower in RLS vs. developed settings (WAZ -2.1 vs. -0.5; HAZ -2.2 vs. -0.9; both P < 0.01). Rate of weight but not height reconstitution during 12 and 24 months was higher in RLS (12-month WAZ change 0.84 vs. 0.17, P < 0.01). Growth deficits persisted in RLS after 2 years ART (P = 0.04). Younger cohort age was associated with greater growth reconstitution. Protease inhibitor and nonnucleoside reverse-transcriptase inhibitor regimens yielded comparable growth. Adjusting for age and setting, cohorts with nutritional supplements had greater growth gains (24-month rate difference: WAZ 0.55, P = 0.03; HAZ 0.60, P = 0.007). Supplement benefits were attenuated after adjusting for baseline cohort growth. CONCLUSION RLS children had substantial growth deficits compared with developed settings counterparts at ART; growth shortfalls in RLS persisted despite reconstitution. Earlier age and nutritional supplementation at ART may improve growth outcomes. Scant data on supplementation limit evaluation of impact and underscores need for systematic data collection regarding supplementation in pediatric ART programmes/cohorts.
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Affiliation(s)
- Christine J McGrath
- aDepartment of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas bDepartment of Global Health cDepartment of Biostatistics dDivision of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington eDepartment of Pediatrics, Boston Medical Center, Boston, Massachusetts fDepartment of Medicine gDepartment of Pediatrics hDepartment of Epidemiology, University of Washington, Seattle, Washington, USA
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Fox MP, Rosen S. Systematic review of retention of pediatric patients on HIV treatment in low and middle-income countries 2008-2013. AIDS 2015; 29:493-502. [PMID: 25565496 DOI: 10.1097/qad.0000000000000559] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There are several published systematic reviews of adult retention in care after antiretroviral therapy (ART) initiation among adults, but limited information on pediatric retention. DESIGN Systematic review of pediatric retention on ART in low and middle-income countries during 2008-2013. METHODS We estimated all-cause attrition (death and loss to follow-up) and retention for pediatric patients receiving first-line ART in routine settings. We searched PubMed, Embase, Cochrane Register, and ISI Web of Science (January 2008-January 2014) and abstracts from AIDS and IAS (2008-2013). We estimated mean retention across cohorts using simple averages; interpolated any time period not reported to, up to the last period reported; summarized total retention in the population using Kaplan-Meier survival curves; and compared pediatric to adult retention. RESULTS We found 39 reports of retention in 45 patient cohorts and 55 904 patients in 23 countries. Among them, 37% of patients not retained in care were known to have died and 63% were lost to follow-up. Unweighted averages of reported retention were 85, 81, and 81% at 12, 24, and 36 months after ART initiation. From life-table analysis, we estimated retention at 12, 24, and 36 months at 88, 72, and 67%. We estimated 36-month retention at 66% in Africa and 74% in Asia. CONCLUSION Pediatric ART retention was similar to that among adults. There were limited data from Asia, only one study from Latin America and the Caribbean, and no data from Eastern Europe, Central Asia, or the Middle East.
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Kalla GCM, Assoumou MCO, Kamgaing N, Monebenimp F, Mbopi-Keou FX. [Impact of antiretroviral therapy on the biological profile of HIV positive children followed-up at Yaounde University Hospital in Cameroon]. Pan Afr Med J 2015; 20:159. [PMID: 26113902 PMCID: PMC4469432 DOI: 10.11604/pamj.2015.20.159.4677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 01/28/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction L'objectif de ce travail était d’évaluer l'impact du traitement antirétroviral sur le profil biologique des enfants VIH positifs suivis au Centre Hospitalier et Universitaire de Yaoundé au Cameroun. Méthodes Il s'agissait d'une étude rétrospective réalisée de Mai 2003 à Décembre 2012 au CHU de Yaoundé au Cameroun. Pour cette étude, nous avons obtenu une clairance éthique. Résultats L’âge moyen était de 54.02±46.34 mois. The sexe ratio était de 0.96 en faveur des garçons. Le diagnostic s’était fait tardivement (74.2%) ainsi que la mise sous traitement (83.3%). Seuls 36 des 116 enfants (31%) avait pu avoir un bilan biologique à l'initiation du traitement antirétroviral et six mois après l'initiation du traitement antirétroviral. Après six mois de traitement, nous avons enregistrés une augmentation significative des paramètres biologiques suivants: taux de glycémie de 0.09g/L (0.75-0.84; p= 0.007), pourcentage de CD4 chez les enfants de moins de 5 ans de 4.62% (20.12-24.75; p = 0.022), valeur absolue de CD4 chez les enfants de plus de 5 ans de 294 cellules/mm3 (151.18-445.18; p = 0.011), le rapport CD4/CD8 de 0.35 (0.55-0.90; p = 0.000). Enfin, après six mois de traitement, on enregistrait une baisse significative de la charge virale du VIH de 3.90 log (5.85-1.95; p = 0.006). Conclusion Il ressort de cette étude que la restauration immunitaire et la suppression virologique peuvent être obtenus après six mois de traitement antirétroviral. Cependant, des efforts doivent encore être faits en ce qui concerne la prise en charge du suivi biologique, gage d'un bon suivi thérapeutique au Cameroun.
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Affiliation(s)
- Ginette Claude Mireille Kalla
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun ; Centre Hospitalier Universitaire, Service de Pédiatrie, Yaoundé, Cameroun
| | | | - Nelly Kamgaing
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun ; Centre Hospitalier Universitaire, Service de Pédiatrie, Yaoundé, Cameroun
| | - Francisca Monebenimp
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun ; Centre Hospitalier Universitaire, Service de Pédiatrie, Yaoundé, Cameroun
| | - Francois-Xavier Mbopi-Keou
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun ; Ministère de la Santé Publique, Yaoundé, Cameroun
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Barennes H, Tat S, Reinharz D, Vibol U. Perceived stigma by children on antiretroviral treatment in Cambodia. BMC Pediatr 2014; 14:300. [PMID: 25492301 PMCID: PMC4276259 DOI: 10.1186/s12887-014-0300-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 11/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background HIV-related stigma diminishes the quality of life of affected patients. Little is known about perceived and enacted stigma of HIV-infected children in resources-limited settings. We documented the prevalence of perceived stigma and associated factors associated among children on antiretroviral therapy (ART) at a referral hospital in Cambodia. Methods After informed consent, a standardized pre-tested 47-item questionnaire was confidentially administered to consecutive children (7 to 15 years) or their guardians if the child was 18 months to 6 years, during their routine ART visits. The questionnaire explored the sociodemographics of the child and the parents, HIV history, adherence to ART, tolerance of ART and perceived stigma. Associations between perceived stigma and the children’s characteristics were measured by bivariate and multivariate analyses. Results Of 183 children, 101 (55.2%) had lost at least one and 45 (24.6%) both parents; 166 (90.7%) went to school. Of 183 children (female: 84, 45.9%, median age 7.0 years, interquartile range: 2.0-9.6), 79 (43.2%) experienced perceived stigma, including rejection by others (26.8%), no invitations to social activities (18.6%) and exclusion from games (14.2%). A total of 43 (23.5%) children were fearful of their disease and 61 (53.9%) of 113 older than 6 years reported knowledge of their HIV status. Of 136 children over five years and eligible for education, 7 (3.8%) could not go to school due to perceived stigma. Incomplete adherence to ART was reported for 17 (9.2%) children. In multivariate analysis, school attendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.0-7.9) and income of less than one dollar per person per day (OR: 2.2, 95% CI: 1.1-4.5) were associated with perceived stigma. Conversely, receipt of social support (OR: 0.4, 95% CI 0.2-0.9) was associated with lower risk of perceived stigma. Conclusion Perceived stigma in pediatric ART patients remains a significant issue in Cambodia. Psychological support and interventions should be developed in hospitals, schools, and underprivileged communities to prevent HIV-related stigma for affected children.
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Affiliation(s)
- Hubert Barennes
- Agence Nationale de Recherche sur le VIH et les Hepatites, Preah Monyvong 5 Blvd, Phnom Penh, Cambodia. .,Institut Francophone pour la Médecine Tropicale, Vientiane, Vientiane, Lao PDR. .,ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, F-33000, Bordeaux, France. .,Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia.
| | - Sovann Tat
- Agence Nationale de Recherche sur le VIH et les Hepatites, Preah Monyvong 5 Blvd, Phnom Penh, Cambodia. .,Stung Treng Regional Training Center for Nursing and Midwifery Cambodia, Stung Treng, Cambodia.
| | - Daniel Reinharz
- Institut Francophone pour la Médecine Tropicale, Vientiane, Vientiane, Lao PDR. .,Département de médecine sociale et préventive, Université Laval, Québec, Canada.
| | - Ung Vibol
- University of Health Science, Phnom Penh, Cambodia.
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Barennes H, Guillet S, Limsreng S, Him S, Nouhin J, Hak C, Srun C, Viretto G, Ouk V, Delfraissy JF, Ségéral O. Virological failure and HIV-1 drug resistance mutations among naive and antiretroviral pre-treated patients entering the ESTHER program of Calmette Hospital in Cambodia. PLoS One 2014; 9:e105736. [PMID: 25166019 PMCID: PMC4148321 DOI: 10.1371/journal.pone.0105736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction In resource limited settings, patients entering an antiretroviral therapy (ART) program comprise ART naive and ART pre-treated patients who may show differential virological outcomes. Methods This retrospective study, conducted in 2010–2012 in the HIV clinic of Calmette Hospital located in Phnom Penh (Cambodia) assessed virological failure (VF) rates and patterns of drug resistance of naive and pre-treated patients. Naive and ART pre-treated patients were included when a Viral Load (VL) was performed during the first year of ART for naive subjects or at the first consultation for pre-treated individuals. Patients showing Virological failure (VF) (>1,000 copies/ml) underwent HIV DR genotyping testing. Interpretation of drug resistance mutations was done according to 2013 version 23 ANRS algorithms. Results On a total of 209 patients, 164 (78.4%) were naive and 45 (21.5%) were ART pre-treated. Their median initial CD4 counts were 74 cells/mm3 (IQR: 30–194) and 279 cells/mm3 (IQR: 103–455) (p<0.001), respectively. Twenty seven patients (12.9%) exhibited VF (95% CI: 8.6–18.2%), including 10 naive (10/164, 6.0%) and 17 pre-treated (17/45, 37.8%) patients (p<0.001). Among these viremic patients, twenty-two (81.4%) were sequenced in reverse transcriptase and protease coding regions. Overall, 19 (86.3%) harbored ≥1 drug resistance mutations (DRMs) whereas 3 (all belonging to pre-treated patients) harbored wild-types viruses. The most frequent DRMs were M184V (86.3%), K103N (45.5%) and thymidine analog mutations (TAMs) (40.9%). Two (13.3%) pre-treated patients harbored viruses that showed a multi-nucleos(t)ide resistance including Q151M, K65R, E33A/D, E44A/D mutations. Conclusion In Cambodia, VF rates were low for naive patients but the emergence of DRMs to NNRTI and 3TC occurred relatively quickly in this subgroup. In pre-treated patients, VF rates were much higher and TAMs were relatively common. HIV genotypic assays before ART initiation and for ART pre-treated patients infection should be considered as well.
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Affiliation(s)
- Hubert Barennes
- Agence Nationale de Recherche sur le VIH et les Hepatites (ANRS), Phnom Penh, Cambodia
- ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, Bordeaux, France
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
- * E-mail:
| | - Stéphanie Guillet
- Agence Nationale de Recherche sur le VIH et les Hepatites (ANRS), Phnom Penh, Cambodia
- Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Sovanvatey Him
- Hospital Calmette, Phnom Penh, Cambodia
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Janin Nouhin
- HIV/Hepatitis Unit, Pasteur Institute, Phnom Penh, Cambodia
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Chanroeurn Hak
- Hospital Calmette, Phnom Penh, Cambodia
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | | | - Gerald Viretto
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Vara Ouk
- Hospital Calmette, Phnom Penh, Cambodia
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Jean Francois Delfraissy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Olivier Ségéral
- Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
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Phongsamart W, Hansudewechakul R, Bunupuradah T, Klinbuayaem V, Teeraananchai S, Prasithsirikul W, Kerr SJ, Akarathum N, Denjunta S, Ananworanich J, Chokephaibulkit K. Long-term outcomes of HIV-infected children in Thailand: the Thailand Pediatric HIV Observational Database. Int J Infect Dis 2014; 22:19-24. [PMID: 24576843 DOI: 10.1016/j.ijid.2013.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the outcomes of antiretroviral therapy (ART) in a large cohort of HIV-infected children in Thailand. METHODS The data were obtained from four collaborative referral sites around the country. Data from 2008 to March 2011 were collected prospectively, and data before 2008 were collected retrospectively. RESULTS Of the 1139 children, 599 (52.6%) were female, and the duration of ART was a median 2.9 years (interquartile range (IQR) 3.3-5.5 years). At ART initiation, the median age was 7.1 years (IQR 3.4-10.0 years), CD4 percentage was 9.0% (IQR 3.0-17.0%), and 61.3% were in World Health Organization (WHO) stage 3 or 4. Seventy-four percent were initiated on an NNRTI-based regimen. The death and lost to follow-up rates were 1.3 (95% confidence interval (CI) 1.1-1.6) and 2.2 (95% CI 1.6-2.6)/100 patient-years of follow-up, respectively. At the last clinic visit of 919 children, the median CD4 percentage was 27.0% (IQR 23.0-32.0%) and 80.2% had HIV-RNA <40 copies/ml. WHO stage 1 or 2 at ART initiation was associated with having a viral load <40 copies/ml (p < 0.002), and baseline CD4 ≥15% and starting with a three-drug regimen were associated with achieving CD4 ≥25% (p<0.001). CONCLUSIONS Although most children initiated ART at low CD4 levels, the majority achieved immune reconstitution and long-term virological control. Earlier treatment may improve these outcomes.
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Affiliation(s)
| | | | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Sirinya Teeraananchai
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Stephen J Kerr
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand; Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | | | | | - Jintanat Ananworanich
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand; Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
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Biressaw S, Abegaz WE, Abebe M, Taye WA, Belay M. Adherence to Antiretroviral Therapy and associated factors among HIV infected children in Ethiopia: unannounced home-based pill count versus caregivers' report. BMC Pediatr 2013; 13:132. [PMID: 24229394 PMCID: PMC3766076 DOI: 10.1186/1471-2431-13-132] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of Antiretroviral Therapy (ART) has brought a remarkable reduction in HIV-related mortality and morbidity both in adults and children living with HIV/AIDS. Adherence to ART is the key to the successful treatment of patients as well as containment of drug resistance. Studies based on caregivers' report have shown that adherence to ART among children is generally good. However, subjective methods such as caregivers' report are known to overestimate the level of adherence. This study determined the rate of adherence and its predictors using unannounced home-based pill count and compared the result with caregivers' report in a tertiary referral hospital in Ethiopia. METHODS A cross-sectional study was conducted between December 1, 2011 and January 30, 2012. The study participants were 210 children on ART and their caregivers attending pediatric ART clinic of Tikur Anbessa Hospital (TAH), Addis Ababa University. Caregivers were interviewed at the ART clinic using a structured questionnaire. Then, unannounced home-based pill count was done 7 days after the interview. RESULTS Caregiver-reported adherence in the past 7 days prior to interview was 93.3%. Estimated adherence using unannounced home-based pill count was found, however, to be 34.8%. On multivariate logistic regression model, children with married [aOR = 7.85 (95% CI: 2.11,29.13)] and widowed/divorced [aOR = 7.14 (95% CI: 2.00,25.46)] caregivers, those who were not aware of their HIV sero-status [aOR = 2.35 (95% CI:1.09, 5.06)], and those with baseline WHO clinical stage III/IV [OR = 3.18 (95% CI: 1.21, 8.40] were more likely to adhere to their ART treatment. On the other hand, children on d4T/3Tc/EFV combination [OR = 0.10 (95% CI: 0.02, 0.53)] were less likely to adhere to their treatment. Caregivers' forgetfulness and child refusal to take medication were reported as the major reasons for missing doses. CONCLUSION The level of adherence based on unannounced home-based pill count was unacceptably low. Interventions are urgently needed to improve adherence to ART among children at TAH. Besides, a longitudinal study measuring adherence combined with clinical parameters (viral load and CD4 count) is needed to identify a simple and reliable measure of adherence in the study area.
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Affiliation(s)
- Silenat Biressaw
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P,O, Box 1176, Addis Ababa, Ethiopia.
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Increased risk of Q151M and K65R mutations in patients failing stavudine-containing first-line antiretroviral therapy in Cambodia. PLoS One 2013; 8:e73744. [PMID: 24015311 PMCID: PMC3756052 DOI: 10.1371/journal.pone.0073744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background Multi-nucleos(t)ide resistance (MNR) mutations including Q151M, K65R mutations, and insertion at codon 69 of HIV-1 reverse transcriptase coding region may confer resistance to all molecules of nucleos(t)ide reverse transcriptase inhibitors (NRTI). The presence of these mutations is an emerging problem compromising non-nucleoside reverse transcriptase inhibitors and protease inhibitors-based therapies. Furthermore, factors associated with selection of these mutations are still not well defined. The current study aimed to evaluate the frequency and to characterize factors associated with the occurrence of multi-nucleos(t)ide resistance mutations among HIV-1 infected patients failing recommended first-line antiretroviral regimens in Cambodia. Methodology/Principal Finding This is a retrospective analysis of HIV-1 drug resistance genotyping of 520 HIV-1 infected patients in virological failure (viral load > 250 copies/mL) while on first-line antiretroviral therapy in Cambodia with at least one reverse transcriptase inhibitor resistance associated mutation. Among these 520 patients, a total of 66 subjects (66/520, 12.7%) presented ≥1 MNR mutation, including Q151M, K65R, and Insert69 for 59 (11.3%), 29 (5.6%), and 2 (0.4%) patients, respectively. In multivariate analysis, both Q151M (p = 0.039) and K65R (p = 0.029) mutations were independently associated with current stavudine- compared to zidovudine-use. Conclusion Such selection of mutations by stavudine drastically limits the choice of antiretroviral molecules available for second-line therapy in resource-limited settings. This finding supports the World Health Organization’s recommendation for stavudine phase-out.
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Coetzer M, Westley B, DeLong A, Tray C, Sophearin D, Nerrienet E, Schreier L, Kantor R. Extensive drug resistance in HIV-infected Cambodian children who are undetected as failing first-line antiretroviral therapy by WHO 2010 guidelines. AIDS Res Hum Retroviruses 2013; 29:985-92. [PMID: 23506238 DOI: 10.1089/aid.2013.0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Antiretroviral therapy in resource-limited settings is monitored clinically and immunologically according to WHO guidelines. Frequent misclassification of virologic failure is reported, mostly in adults, leading to early therapy switch or late failure diagnosis. Pediatric treatment monitoring and resistance data upon first-line failure are limited, particularly when the 2010-WHO pediatric guidelines are used without routine viral load monitoring. We previously reported high treatment failure misclassification rates by pediatric 2010 guidelines in Cambodian children on first-line therapy. Here we determine the extent and patterns of resistance, with yearly viral load and 6-monthly CD4. Drug resistance mutations were determined using the IAS-USA 2011 list. Predicted resistance interpretation was determined with Stanford Database tools. Fifty-one children with available genotypes met inclusion criteria. All but one (subtype B) were CRF01_AE. The most common regimen was stavudine, lamivudine, and nevirapine (96%), taken for a median of 2.2 years. Resistance was seen in 98%; 96% to nucleoside and nonnucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs); 51% with ≥4 mutations. The most common NRTI mutations were 184V/I and 67N and the most common NNRTI mutations were 181C/Y/I/V and 190A/S. A total of 22% had multiresistant mutations and 18% had predicted high-level resistance to subsequent therapy options didanosine, abacavir, etravirine, and tenofovir. In 98% of Cambodian children misclassified as nonfailing first-line therapy by 2010 guidelines, 51% had extensive drug resistance to current and 18% to subsequent antiretroviral therapy. Affordable routine viral load monitoring allowing for early and more accurate treatment failure diagnosis is desperately needed in resource-limited settings.
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Affiliation(s)
- Mia Coetzer
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin Westley
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Allison DeLong
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Chhraing Tray
- Department of Pediatrics, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Dim Sophearin
- Department of Pediatrics, Angkor Hospital for Children, Siem Reap, Cambodia
| | | | - Leeann Schreier
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Rami Kantor
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, Rhode Island
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Penda CI, Bebey FS, Mangamba DK, Moukoko ECE, Ngwa V, Makouet N, Bissek AC, Minkemdefo BD, Tetanye E, Ndombo PK. [Treatment failure in children infected with HIV in routine follow-up in a resource-limited setting in Cameroon]. Pan Afr Med J 2013; 15:80. [PMID: 24171063 PMCID: PMC3810220 DOI: 10.11604/pamj.2013.15.80.2754] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/20/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction L'objectif de cette étude était de déterminer les facteurs associés aux échecs thérapeutiques chez les enfants infectés par le VIH à l'Hôpital Laquintinie de Douala. Méthodes Une étude transversale rétrospective a été menée sur une période de 5 mois en 2010, recrutant 222 enfants âgés de 1 à 18 ans et sous TARV depuis au moins 24 semaines. Les données sociodémographiques, cliniques, biologiques et de l'observance thérapeutique des patients ont été collectés à partir des dossiers des patients, et analysées avec le logiciel SPSS (version 16). Résultats 39 (17,6%) des enfants étaient en échec thérapeutique (délai moyen de survenue 26,8 mois) et 73,4% d'entre eux sont passés en seconde ligne. Les garçons avaient en moyenne un risque 5 fois plus élevé de faire un échec thérapeutique que les filles (OR=3,9; p=0,035). 94,4% des enfants suivis avaient un faible taux de CD4 à l'initiation (‘ 25%) associé au risque élevé d’échec thérapeutique (OR=5,2; p=0,007). Les enfants issus de famille monoparentale représentaient près de la moitié des cas d’échecs thérapeutiques. Sur 39 cas en échec thérapeutique, 41% des enfants étaient des orphelins. Parmi les enfants sous TARV, 46% prenaient leur trithérapie sous forme de médicaments séparés parmi lesquels 52,1% étaient en échec thérapeutique. Conclusion Les échecs thérapeutiques et le passage en seconde ligne dépendaient du contexte familial des enfants, de leur statut immunologique à l'initiation du traitement, de leur sexe et de la forme galénique du TARV.
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Affiliation(s)
- Calixte Ida Penda
- Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Cameroun ; Hôpital Laquintinie de Douala, Cameroun
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McLaughlin S, Swenson LC, Hu S, Hughes P, Harrigan PR, Coombs RW, Frenkel LM. Development of a novel codon-specific polymerase chain reaction for the detection of CXCR4-utilizing HIV type 1 subtype B. AIDS Res Hum Retroviruses 2013; 29:814-25. [PMID: 23343425 PMCID: PMC3636599 DOI: 10.1089/aid.2012.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Insight concerning the switch in HIV-1 coreceptor use will lead to a better understanding of HIV-1 pathogenesis and host-virus dynamics. Predicting CXCR4 utilization by analyzing HIV-1 envelope consensus sequences is highly specific, but minority variants in the viral population are often missed resulting in low sensitivity. Commercial phenotypic assays are costly, and the development of sensitive in-house phenotypic assays to detect CXCR4-using HIV may not be feasible for some laboratories. A sensitive, inexpensive genotyping assay was developed to detect viral sequences associated with CXCR4-utilizing virus (X4). Codon-specific primer pairs were used to detect X4-associated codons at five positions in the HIV-1 envelope V3 loop (11, 13, 24, 25, and 32). Sixty plasma samples from HIV-1-infected individuals were analyzed by consensus sequencing and codon-specific PCR (CS-PCR). Forty-six of these were also phenotyped by Trofile or Enhanced Sensitivity Trofile (ESTA). CS-PCR detected X4 variants 17% more often than 11/24/25 consensus sequencing alone (n=60), 30% more often than Trofile (n=27), and in a limited data set, 16% more often than ESTA (n=19). CS-PCR combined with consensus sequencing had approximately 80% concordance with ESTA.
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Evaluation of quantification of HIV-1 RNA viral load in plasma and dried blood spots by use of the semiautomated Cobas Amplicor assay and the fully automated Cobas Ampliprep/TaqMan assay, version 2.0, in Kisumu, Kenya. J Clin Microbiol 2013; 51:1208-18. [PMID: 23390278 DOI: 10.1128/jcm.03048-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In Kenya, HIV-1 viral load monitoring is commonly performed with the Cobas Amplicor using plasma specimens. Interest is growing in transitioning to real-time PCR (RT-PCR), such as the Cobas Ampliprep/Cobas TaqMan (CAP/CTM), using dried blood spots (DBS). Before implementation, direct evaluation of the two assays using DBS field specimens is required. This study compares the sensitivity, specificity, negative and positive predictive values (NPV and PPV, respectively), concordance, and agreement between HIV-1 viral load measurements using plasma and DBS specimens obtained from 512 HIV-1-infected pregnant females enrolled in the Kisumu Breastfeeding Study and tested with the Cobas Amplicor and CAP/CTM assays. The sensitivity and NPV of viral load detection in DBS specimens were higher with CAP/CTM (sensitivity, 100%; 95% confidence interval [CI], 99.1 to 100.0%; NPV, 100%; 95% CI, 59.0 to 100.0%) than the Cobas Amplicor (sensitivity, 96.6%; 95% CI, 94.3 to 98.1%; NPV, 58.8%; 95% CI, 40.7 to 75.4%). The PPVs were comparable between both assays when using DBS. The specificity of viral load detection in DBS specimens was lower with CAP/CTM (77.8%; 95% CI, 40.0 to 97.2%) than that of the Cobas Amplicor (95.2%; 95% CI, 76.2 to 99.9%). Good concordance and agreement were observed when paired plasma and DBS specimens were tested with both assays. Lower specificity with the CAP/CTM is likely due to proviral HIV-1 DNA amplification and lower detection limits with RT-PCR. However, the CAP/CTM has better sensitivity and higher throughput than the Cobas Amplicor. These findings suggest that DBS may be a suitable alternative to plasma when using RT-PCR, which could increase access to viral load monitoring in resource-limited settings.
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Sasaki Y, Kakimoto K, Dube C, Sikazwe I, Moyo C, Syakantu G, Komada K, Miyano S, Ishikawa N, Kita K, Kai I. Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients. Ann Clin Microbiol Antimicrob 2012; 11:34. [PMID: 23270312 PMCID: PMC3599627 DOI: 10.1186/1476-0711-11-34] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 12/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia. METHODS This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence. RESULTS Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%). CONCLUSIONS The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.
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Affiliation(s)
- Yuri Sasaki
- Department of Infection Control and Prevention, Graduate School of Nursing, Nagoya City University, Kawasumi 1, Mizuho-ku, Nagoya-shi, Aichi, 467-8601, Japan.
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Westley BP, DeLong AK, Tray CS, Sophearin D, Dufort EM, Nerrienet E, Schreier L, Harwell JI, Kantor R. Prediction of treatment failure using 2010 World Health Organization Guidelines is associated with high misclassification rates and drug resistance among HIV-infected Cambodian children. Clin Infect Dis 2012; 55:432-40. [PMID: 22539664 PMCID: PMC3491779 DOI: 10.1093/cid/cis433] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 03/30/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) in resource-limited settings (RLSs) is monitored clinically and immunologically, according to World Health Organization (WHO) or national guidelines. Revised WHO pediatric guidelines were published in 2010, but their ability to accurately identify virological failure is unclear. METHODS We evaluated performance of WHO 2010 guidelines and compared them with WHO 2006 and Cambodia 2011 guidelines among children on ≥6 months of first-line ART at Angkor Hospital for Children between January 2005 and September 2010. We determined sensitivity, specificity, positive and negative predictive values, and accuracy using bootstrap resampling to account for multiple tests per child. Human immunodeficiency virus (HIV) resistance was compared between those correctly and incorrectly identified by each guideline. RESULTS Among 457 children with 1079 viral loads (VLs), 20% had >400 copies/mL. For children with WHO stage 1/2 HIV, misclassification as failure (met CD4 failure criteria, but VL undetectable) was 64% for WHO 2006 guidelines, 33% for WHO 2010 guidelines, and 81% for Cambodia 2011 guidelines; misclassification as success (did not meet CD4 failure, but VL detectable) was 11%, 12%, and 12%, respectively. For children with WHO stage 3/4 HIV, misclassification as failure was 35% for WHO 2006 guidelines, 40% for WHO 2010 guidelines, and 43% for Cambodia 2011 guidelines; misclassification as success was 13%, 24%, and 21%, respectively. Compared with WHO 2006 guidelines, WHO 2010 guidelines significantly increased the risk of misclassification as success in stage 3/4 HIV (P < .05). The WHO 2010 guidelines failed to identify 98% of children with extensive reverse-transcriptase resistance. CONCLUSIONS In our cohort, lack of virological monitoring would result in unacceptable treatment failure misclassification, leading to premature ART switch and resistance accumulation. Affordable virological monitoring suitable for use in RLSs is desperately needed.
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Affiliation(s)
- Benjamin P Westley
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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Ambulatory multi-drug resistant tuberculosis treatment outcomes in a cohort of HIV-infected patients in a slum setting in Mumbai, India. PLoS One 2011; 6:e28066. [PMID: 22145022 PMCID: PMC3228724 DOI: 10.1371/journal.pone.0028066] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 10/31/2011] [Indexed: 11/28/2022] Open
Abstract
Background India carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India. Methods HIV-infected patients with suspected MDR-TB were referred to the MSF-clinic by public Antiretroviral Therapy (ART) Centers or by a network of community non-governmental organizations. Patients were initiated on either empiric or individualized second-line TB-treatment as per WHO recommendations. MDR-TB treatment was given on an ambulatory basis and under directly observed therapy using a decentralized network of providers. Patients not already receiving ART were started on treatment within two months of initiating MDR-TB treatment. Results Between May 2007 and May 2011, 71 HIV-infected patients were suspected to have MDR-TB, and 58 were initiated on treatment. MDR-TB was confirmed in 45 (78%), of which 18 (40%) were resistant to ofloxacin. Final treatment outcomes were available for 23 patients; 11 (48%) were successfully treated, 4 (17%) died, 6 (26%) defaulted, and 2 (9%) failed treatment. Overall, among 58 patients on treatment, 13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, two (3%) failed treatment, and 23 (40%) were alive and still on treatment at the end of the observation period. Twenty-six patients (45%) experienced moderate to severe adverse events, requiring modification of the regimen in 12 (20%). Overall, 20 (28%) of the 71 patients with MDR-TB died, including 7 not initiated on treatment. Conclusions Despite high fluoroquinolone resistance and extensive prior second-line treatment, encouraging results are being achieved in an ambulatory MDR-T- program in a slum setting in India. Rapid scale-up of both ART and second-line treatment for MDR-TB is needed to ensure survival of co-infected patients and mitigate this growing epidemic.
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