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Mesic A, Decroo T, Florence E, Ritmeijer K, van Olmen J, Lynen L. Systematic review on cumulative HIV viraemia among people living with HIV receiving antiretroviral treatment and its association with mortality and morbidity. Int Health 2024; 16:261-278. [PMID: 37823452 PMCID: PMC11062202 DOI: 10.1093/inthealth/ihad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND We performed a systematic review to generate evidence on the association between cumulative human immunodeficiency virus (HIV) viraemia and health outcomes. METHODS Quantitative studies reporting on HIV cumulative viraemia (CV) and its association with health outcomes among people living with HIV (PLHIV) on antiretroviral treatment (ART) were included. We searched MEDLINE via PubMed, Embase, Scopus and Web of Science and conference abstracts from 1 January 2008 to 1 August 2022. RESULTS The systematic review included 26 studies. The association between CV and mortality depended on the study population, methods used to calculate CV and its level. Higher CV was not consistently associated with greater risk of acquire immunodeficiency syndrome-defining clinical conditions. However, four studies present a strong relationship between CV and cardiovascular disease. The risk was not confirmed in relation of increased hazards of stroke. Studies that assessed the effect of CV on the risk of cancer reported a positive association between CV and malignancy, although the effect may differ for different types of cancer. CONCLUSIONS CV is associated with adverse health outcomes in PLHIV on ART, especially at higher levels. However, its role in clinical and programmatic monitoring and management of PLHIV on ART is yet to be established.
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Affiliation(s)
- Anita Mesic
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
- Médecins Sans Frontières, Public Health Department, Plantage Middenlaan 14, 1018DD Amsterdam, The Netherlands
- University of Antwerp, Faculty of Medicine and Health Sciences, Family Medicine and Population Health, Doornstraat 331, 2610 Antwerpen, Belgium
| | - Tom Decroo
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
| | - Eric Florence
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital of Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Koert Ritmeijer
- Médecins Sans Frontières, Public Health Department, Plantage Middenlaan 14, 1018DD Amsterdam, The Netherlands
| | - Josefien van Olmen
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Family Medicine and Population Health, Doornstraat 331, 2610 Antwerpen, Belgium
| | - Lutgarde Lynen
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
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Mena ZB, Wolka E, Dana T, Asmare G, Mena MB, Lerango TL. Incidence and predictors of treatment failure among children with HIV on first-line antiretroviral therapy in Wolaita zone, Southern Ethiopia: A multicenter retrospective cohort study. Heliyon 2023; 9:e20737. [PMID: 37842572 PMCID: PMC10569990 DOI: 10.1016/j.heliyon.2023.e20737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
Background Antiretroviral therapy has improved the life expectancy of HIV-positive children. Treatment failure and drug resistance among children with HIV remain major public health concerns despite the rise in ART use. A dearth of evidence exists regarding treatment failure among Ethiopian children from multicenter settings. Therefore, this study sought to assess the incidence and predictors of treatment failure among children with HIV on first-line antiretroviral therapy at health facilities in Wolaita zone, Southern Ethiopia. Methods A facility-based retrospective cohort study was conducted from January 1, 2017, to December 30, 2021, at health facilities providing ART in Wolaita zone, Southern Ethiopia. A total of 425 children with HIV on first-line ART were selected using a simple random sampling technique. Data were extracted by reviewing the patient's medical record. The data were entered using epi-data version 4.6 and exported to STATA version 15 for analysis. Both bi-variable and multivariable Cox regression analysis were employed. A p-value of less than 0.05 and a hazard ratio with 95 % CI was used to estimate the association between the predictor factors and treatment failure. Results The overall incidence density rate of treatment failure was 3.2 per 1000 person-months of observation (95 % CI: 2.4-4.6). The factors significantly associated with antiretroviral treatment failure were caregiver marital status, single (AHR = 4.86, 95 % CI: 1.52, 15.60), and widowed (AHR = 3.75, 95 % CI: 1.16, 12.11), duration of follow-up (AHR = 4.95, 95 % CI: 1.81, 13.54), and baseline CD4 count (AHR = 4.70, 95 % CI: 1.68, 13.14). Conclusion The incidence rate of ART failure among children with HIV was found to be significant. Low baseline CD4 count, short follow-up duration on ART, and having a single or widowed caregiver were significantly associated with antiretroviral treatment failure. Early identification of children with low CD4 count and subsequent initiation of ART should be emphasized by stakeholders working in HIV care programs. Healthcare professionals should pay special attention to and regularly monitor the treatment progress of children who have single or widowed caregivers, and those with shorter duration of follow-ups.
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Affiliation(s)
- Zufan Berhanu Mena
- School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eskinder Wolka
- School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tadele Dana
- School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare
- School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Muluken Berhanu Mena
- School of Pharmacy, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Temesgen Leka Lerango
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Gelaw B, Dessalegn L, Alem E, Tekalign T, Lankirew T, Eshetu K, Marew C, Chekole B, Kassaw A. Prevalence and associated factors of treatment failure among children on ART in Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0261611. [PMID: 35421084 PMCID: PMC9009617 DOI: 10.1371/journal.pone.0261611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As the use of antiretroviral therapy (ART) increases, the issue of treatment failure is still a global challenge, particularly in a resource limited settings including Ethiopia. The results of former studies in Ethiopia were highly variable and inconsistent across studies. Thus, this systematic review and meta-analysis intended to provide the pooled estimation of treatment failure and associated factors among children on antiretroviral therapy. METHODS We searched international databases (i.e., PubMed, Google Scholar, Web of Science, Ethiopian Universities' online repository library, Scopus, and the Cochrane Library) during the period of February 30 to April 7, 2021. All identified observational studies reporting the proportion of treatment failure among HIV positive children in Ethiopia were included. Heterogeneity of the studies was checked using I2 test and Cochrane Q test statistics. We run Begg's regression test to assess publication bias. A random-effects meta-analysis model was performed to estimate the pooled prevalence of treatment failure. RESULTS The estimated pooled prevalence of treatment failure among children in Ethiopia was 12.34 (95%CI: 8.59, 16.10). Subgroup analysis of this review showed that the highest prevalence was observed in Addis Ababa (15.92%), followed by Oromia region (14.47%). Poor ART adherence (AOR = 2.53, CI: 2.03, 4.97), advanced WHO clinical staging (AOR = 1.66, CI: 1.24, 3.21), and opportunistic infections (AOR = 2.64 CI: 2.19, 4.31 were found to be significantly associated factors with childhood treatment failure. CONCLUSIONS This study revealed that treatment failure among children on ART was high in Ethiopia. Poor ART adherence, advanced WHO clinical staging, opportunistic infections, and low level of CD4 cell counts increased the risk of treatment failure.
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Affiliation(s)
- Belete Gelaw
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Lemma Dessalegn
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eyasu Alem
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tiwabwork Tekalign
- Department of Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tadele Lankirew
- Department of Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu
- Department of Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Chalie Marew
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Amare Kassaw
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Alhassan RK, Ketor CE, Ashinyo A, Ashinyo ME, Nutor JJ, Adjadeh C, Sarkodie E. Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings. SAGE Open Med 2021; 9:20503121211036142. [PMID: 34377475 PMCID: PMC8326618 DOI: 10.1177/20503121211036142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach. Methods This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019. Results Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators. Conclusion Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention.
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Affiliation(s)
- Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Courage Edem Ketor
- Pharmacy Department, Jasikan District Hospital, Ghana Health Service, Jasikan, Ghana
| | - Anthony Ashinyo
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | - Mary Eyram Ashinyo
- Department of Quality Assurance and Safety, Ghana Health Service, Accra, Ghana
| | - Jerry John Nutor
- Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Conrad Adjadeh
- Pharmacy Department, Margaret Marquart Catholic Hospital Kpando, Kpando, Ghana
| | - Emmanuel Sarkodie
- Pharmacy Department, Kwame Nkrumah University of Science and Technology (KNUST) Hospital, Kumasi, Ghana
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Long-Term Immunological and Virological Outcomes in Children Receiving Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia. J Immunol Res 2021; 2021:2498025. [PMID: 33928167 PMCID: PMC8053046 DOI: 10.1155/2021/2498025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine immunological and virological failure and associated factors among children infected with human immunodeficiency virus receiving antiretroviral treatments at Hawassa University Hospital, Southern Ethiopia. Methods A hospital-based cross-sectional study was conducted among 273 HIV-infected children from July 1 to December 1, 2019. Data were collected using a structured questionnaire and review of patient records. Blood samples for viral load and CD4 count were collected. Data were analyzed using SPSS version 20. Significance group comparison was done by the Kaplan-Meier log-rank test. The Cox proportional hazard model was used to select significant factors of the variability between groups. Results A total of 273 children, between the age ranges of 1 to 14 years, were included. Of these, 139 (50.9%) and 134 (49.1%) were males and females, respectively. Children from the rural area were almost five times more vulnerable for virological and immunological failure than those children from the urban area (AOR = 4.912, (1.276-8.815), P = 0.032). The overall viral load suppression was 196 (71.8%) with a good adherence of 226 (82.9%). Nonsuppressed HIV viral load was found to be 77 (28.2%) which had two times more viral load copies (AOR = 2.01, (1.21–2.66), P = 0.001) when compared to those who had suppressed viral load copies. The proportions of children who had immunological nonresponse were 45.6% (21 out of 46), 30.4% (14 out of 46), and 23.9% (11 out of 46) among children with baseline CD4 of <200, 201-500, and >500 cells/μl, respectively. Unimproved outcomes among females were noted for immunological and virological failure in this study (AOR = 1.901, (1.038-3.481), P = 0.038). Conclusion In conclusion, the highly active antiretroviral treatment appeared highly effective in terms of immunological and virological long-term outcomes. However, viral suppression (71.8%) in our study was far apart from the UNAIDS target of 90% in 2020. For that reason, strengthening adherence counseling and early initiation of HAART is important.
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Kibalama Ssemambo P, Nalubega-Mboowa MG, Owora A, Serunjogi R, Kironde S, Nakabuye S, Ssozi F, Nannyonga M, Musoke P, Barlow-Mosha L. Virologic response of treatment experienced HIV-infected Ugandan children and adolescents on NNRTI based first-line regimen, previously monitored without viral load. BMC Pediatr 2021; 21:139. [PMID: 33752636 PMCID: PMC7983217 DOI: 10.1186/s12887-021-02608-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansion of PEPFAR programs since 2004 and introduction of “Test and Treat” WHO guidelines in 2015. As ART access increases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL) monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on the comparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS). Methods HIV-infected Ugandan children aged 1–12 years from HIV-care programs with > 1 year of first-line ART using only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligible children were stratified by VL ≤ 400 and > 400 copies/ml randomized to clinical and immunological (control) versus clinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48 weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used to compare the prevalence of viral suppression between study arms and identify factors associated with viral suppression. Results At baseline all children (n = 142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third of ART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartile range [IQR]: 5–9) and 43% were female. Overall, the odds of viral suppression were not different between study arms: (arm by week interaction, p = 0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17, p = 0.57) and did not change over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46, p = 0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74, p = 0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61; 95% CI: 0.42, 0.87, p < .01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL. Conclusion With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure in RLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial registration ClinicalTrials.gov NCT04489953, 28 Jul 2020. Retrospectively registered. (https://register.clinicaltrials.gov).
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Affiliation(s)
- Phionah Kibalama Ssemambo
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.
| | - Mary Gorrethy Nalubega-Mboowa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Nsambya Home Care Project (NHC), Kampala, Uganda.,Clarke International University (Formerly IHSU), Namuwongo, Kampala, Uganda
| | - Arthur Owora
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Indiana, USA
| | - Robert Serunjogi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| | | | - Sarah Nakabuye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| | | | | | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
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Getawa S, Fentahun A, Adane T, Melku M. Antiretroviral Treatment Failure and Associated Factors Among HIV-Infected Children on Antiretroviral Therapy: A Retrospective Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:229-237. [PMID: 33664596 PMCID: PMC7921627 DOI: 10.2147/hiv.s294046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Background HIV/AIDS-associated morbidity and mortality have reduced since the introduction of antiretroviral therapy (ART). Treatment failure is one of the causes of mortality, morbidity, and the development of drug-resistant viral strains. Therefore, this research aims to assess the prevalence and associated factors of treatment failure among children with HIV/AIDS on antiretroviral therapy attending the University of Gondar Specialized Referral Hospital, Northwest Ethiopia. Methods A retrospective study was conducted on 200 children registered for ART from 2005 to 2017. Data regarding patients’ socio-demographic, baseline clinical characteristics, and treatment-related information were collected through a review of their medical records. Data were entered into Epi-info version 3.5.3 and analyzed using statistical package for social sciences (SPSS) version 21 software. To summarize characteristics of the study participant’s descriptive statistics were done. Bivariable and multivariable binary logistic regression were fitted to identify factors associated with treatment failure. The odds ratio and 95% confidence interval (CI) were calculated to assess the strength of the association and P-value<0.05 in the multivariable regression was considered as statistically significant. Results The prevalence of ART failure was 12.5% (95% CI: 7.88, 17.12), clinical failure was the most common followed by immunologic failure with only a small proportion having both clinical and immunologic failure. The mean time to develop treatment failure after initiation of the first-line regimen was 22.28 ± 24.00 months. Being male (AOR= 3.15; 95% CI: 1.18–8.39), co-infected with tuberculosis (TB) at baseline (AOR= 2.37; 95% CI: 1.23–8.84), being on ART for a long period (>36 months) (AOR= 1.01; 95% CI: 1.34–2.89), and regimen change (AOR=9.22; 95% CI: 3.36–25.03) were factors of ART failure. Conclusion In this study, there is significant treatment failure among HIV-infected children. Having co-infection, being on ART for a long period, regimen change, and being male were found to be independent factors of treatment failure in children. Therefore, timely identification and monitoring of ART failure should be necessary to enhance the benefit and to prevent further complications. Prophylaxis for opportunistic infections such as co-trimoxazole preventive therapy should continue to recover the immunological status of the child.
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Affiliation(s)
- Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abaynesh Fentahun
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Osman FT, Yizengaw MA. Virological Failure and Associated Risk Factors among HIV/AIDS Pediatric Patients at the ART Clinic of Jimma university Medical Center, Southwest Ethiopia. Open AIDS J 2020. [DOI: 10.2174/1874613602014010061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Pediatric antiretroviral treatment failure is an under-recognized issue that receives inadequate attention in the field of pediatrics and within HIV treatment programs. Despite the reduction in morbidity and mortality, a considerable proportion of patients fail to achieve a sustained virologic response to therapy. Thus virological failure is an increasing concern globally.
Objective:
This study aimed to assess the virological failure and associated risk factors among HIV/AIDS pediatric patients at Antiretroviral Treatment (ART) follow up clinic of Jimma University Medical Center, southwest Ethiopia.
Methods:
An institution based cross-sectional study was conducted at the ART follow-up clinic of Jimma University Medical Center. A structured English version checklist was developed and used for data extraction from patients’ charts from April -May 2019. Then the data was coded and entered using epi data 4.2 and exported to statistical package for social science (SPSS version 22) for analysis. Descriptive analysis was conducted for categorical as well as continuous variables. Multivariable logistic regression was performed in a backward, step-wise manner until a best-fit model was found.
Results:
Of 140 HIV/AIDS pediatric patients enrolled in this study, 72(51.4%) were male and the mean age was 9.7±3.3 Years. ABC-3TC-NVP was the commonly used ART medication in this population, which was 37.1% followed by AZT-3TC-EFV(32.1%). The mean duration of antiretroviral treatment (ART) follow-up was 63.8±29.4 months. Among the study population, 11.0% of them had virological failure. Weight at ART initiation [OR=1.104, 95 CI% [1.013-1.203], p=0.024] and WHO clinical stage 3 [AOR=0.325, 95CI, 0.107-0.991,P=0.048] were the significant risk factors for the virological failure.
Conclusion:
A significant proportion of HIV/AIDS pediatric patients had virological failure. Weight at ART initiation and patients having WHO clinical stage 3 were risk factors associated with virological failure in this study. Governmental and non-governmental concerned bodies should invest their effort to devise strategies for the achievement of HIV/AIDS treatment targets.
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Mossoro-Kpinde CD, Gody JC, Mboumba Bouassa RS, Moussa S, Jenabian MA, Péré H, Charpentier C, Matta M, Longo JDD, Grésenguet G, Djoba Siawaya JF, Bélec L. Escalating and sustained immunovirological dissociation among antiretroviral drug-experienced perinatally human immunodeficiency virus-1-infected children and adolescents living in the Central African Republic: A STROBE-compliant study. Medicine (Baltimore) 2020; 99:e19978. [PMID: 32481261 PMCID: PMC7249904 DOI: 10.1097/md.0000000000019978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Sub-Saharan Africa has the vast majority (∼90%) of new pediatric acquired immunodeficiency syndrome cases worldwide. Biologically monitoring HIV-infected pediatric populations remains challenging. The differential interest of human immunodeficiency virus (HIV)-1 RNA loads and CD4 T-cell counts is debated for the treatment of pediatric acquired immunodeficiency syndrome patients.Long-term antiretroviral treatment (ART) outcomes regarding immunological and virological surrogate markers were longitudinally evaluated between 2009 and 2014 (over 57 months) in 245 perinatally HIV-1-infected children and adolescents born from HIV-infected mothers, treated at inclusion for at least 6 months by the World Health Organization-recommended ART in Bangui, Central African Republic.Patients were monitored over time biologically for CD4 T-cell counts, HIV-1 RNA loads, and drug resistance mutation genotyping.Children lost to follow-up totaled 6%. Four categories of immunovirological responses to ART were observed. At baseline, therapeutic success with sustained immunological and virological responses was observed in 80 (32.6%) children; immunological and virologic nonresponses occurred in 32 (13.0%) children; finally, the majority (133; 54.2%) of the remaining children showed discordant immunovirological responses. Among them, 33 (13.4%) children showed rapid virological responses to ART with an undetectable viral load, whereas immunological responses remained absent after 6 months of treatment and increased progressively over time in most of the cases, suggesting slow immunorestoration. Notably, nearly half of the children (40.8% at baseline and 48.2% at follow-up) harbored discordant immunovirological responses with a paradoxically high CD4 T-cell count and HIV-1 RNA load, which are always associated with high levels of drug resistance mutations. The latter category showed a significant increase over time, with a growth rate of 1.23% per year of follow-up.Our STROBE-compliant study demonstrates the high heterogeneity of biological responses under ART in children with frequent passage from 1 category to another over time. Close biological evaluation with access to routine plasma HIV-1 RNA load monitoring is crucial for adapting the complex outcomes of ART in HIV-infected children born from infected mothers.
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Affiliation(s)
| | - Jean-Chrysostome Gody
- Faculté des Sciences de la Santé, Université de Bangui
- Complexe Pédiatrique, Bangui, Central African Republic
| | - Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale d’Infectiologie Tropicale, Franceville, Gabon
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Sandrine Moussa
- Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Mohammad-Ali Jenabian
- Département des Sciences Biologiques et Centre de Recherche BioMed, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Hélène Péré
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Mathieu Matta
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Jean De Dieu Longo
- Faculté des Sciences de la Santé, Université de Bangui
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Gérard Grésenguet
- Faculté des Sciences de la Santé, Université de Bangui
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | | | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
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10
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Assemie MA, Alene M, Ketema DB, Mulatu S. Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. Glob Health Res Policy 2019; 4:32. [PMID: 31687474 PMCID: PMC6820995 DOI: 10.1186/s41256-019-0120-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia. METHODS Relevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I 2 tests were used to assess the heterogeneity of the studies. RESULTS From 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I 2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure. CONCLUSION In this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.
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Affiliation(s)
- Moges Agazhe Assemie
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Muluneh Alene
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Selishi Mulatu
- Department of Nursing, School of Health Science Bahir Dar University, Bahir Dar, Ethiopia
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11
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Cluver L, Pantelic M, Orkin M, Toska E, Medley S, Sherr L. Sustainable Survival for adolescents living with HIV: do SDG-aligned provisions reduce potential mortality risk? J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485739 PMCID: PMC5978664 DOI: 10.1002/jia2.25056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction The Sustainable Development Goals (SDGs) present a groundbreaking global development agenda to protect the most vulnerable. Adolescents living with HIV in Sub‐Saharan Africa continue to experience extreme health vulnerabilities, but we know little about the impacts of SDG‐aligned provisions on their health. This study tests associations of provisions aligned with five SDGs with potential mortality risks. Methods Clinical and interview data were gathered from N = 1060 adolescents living with HIV in rural and urban South Africa in 2014 to 2015. All ART‐initiated adolescents from 53 government health facilities were identified, and traced in their communities to include those defaulting and lost‐to‐follow‐up. Potential mortality risk was assessed as either: viral suppression failure (1000+ copies/ml) using patient file records, or adolescent self‐report of diagnosed but untreated tuberculosis or symptomatic pulmonary tuberculosis. SDG‐aligned provisions were measured through adolescent interviews. Provisions aligned with SDGs 1&2 (no poverty and zero hunger) were operationalized as access to basic necessities, social protection and food security; An SDG 3‐aligned provision (ensure healthy lives) was having a healthy primary caregiver; An SDG 8‐aligned provision (employment for all) was employment of a household member; An SDG 16‐aligned provision (protection from violence) was protection from physical, sexual or emotional abuse. Research partners included the South African national government, UNICEF and Pediatric and Adolescent Treatment for Africa. Results 20.8% of adolescents living with HIV had potential mortality risk – i.e. viral suppression failure, symptomatic untreated TB, or both. All SDG‐aligned provisions were significantly associated with reduced potential mortality risk: SDG 1&2 (OR 0.599 CI 0.361 to 0.994); SDG 3 (OR 0.577 CI 0.411 to 0.808); SDG 8 (OR 0.602 CI 0.440 to 0.823) and SDG 16 (OR 0.686 CI 0.505 to 0.933). Access to multiple SDG‐aligned provisions showed a strongly graded reduction in potential mortality risk: Among adolescents living with HIV, potential mortality risk was 38.5% with access to no SDG‐aligned provisions, and 9.3% with access to all four. Conclusions SDG‐aligned provisions across a range of SDGs were associated with reduced potential mortality risk among adolescents living with HIV. Access to multiple provisions has the potential to substantially improve survival, suggesting the value of connecting and combining SDGs in our response to paediatric and adolescent HIV.
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Affiliation(s)
- Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Marija Pantelic
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.,International HIV/AIDS Alliance, Hove, United Kingdom
| | - Mark Orkin
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.,Development Pathways to Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.,AIDS and Society Research Unit, University of Cape Town, Cape Town, South Africa
| | - Sally Medley
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lorraine Sherr
- Department of Global Health, University College London, London, United Kingdom
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12
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Lesosky M, Glass T, Rambau B, Hsiao NY, Abrams EJ, Myer L. Bias in the estimation of cumulative viremia in cohort studies of HIV-infected individuals. Ann Epidemiol 2019; 38:22-27. [PMID: 31537405 DOI: 10.1016/j.annepidem.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/04/2019] [Accepted: 08/16/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The use of cumulative measures of exposure to raised HIV viral load (viremia copy-years) is increasingly common in HIV prevention and treatment epidemiology due to the association of long-term elevated viral load with more rapid progression to disease. We sought to estimate the magnitude and direction of bias in a cumulative measure of viremia caused by different frequency of sampling and duration of follow-up. METHODS We simulated longitudinal viral load measures and reanalyzed cohort study data sets with longitudinal viral load measurements under different sampling strategies to estimate cumulative viremia. RESULTS In both simulated and observed data, estimates of cumulative viremia by the trapezoidal rule show systematic upward bias when there are fewer sampling time points and/or increased duration between sampling time points, compared with estimation of full time series. Absolute values of cumulative viremia vary appreciably by the patterns of viral load over time, even after adjustment for total duration of follow-up. CONCLUSIONS Sampling bias due to differential frequency of sampling appears extensive and of meaningful magnitude in measures of cumulative viremia. Cumulative measures of viremia should be used only in studies with sufficient frequency of viral load measures and always as relative measures.
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Affiliation(s)
- Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Observatory, South Africa.
| | - Tracy Glass
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Observatory, South Africa
| | - Brian Rambau
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Observatory, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, University of Cape Town and National Health Laboratory Services, Observatory, South Africa
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University and College of Physicians and Surgeons, Columbia University, New York, NY
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Observatory, South Africa
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13
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Yihun BA, Kibret GD, Leshargie CT. Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study. PLoS One 2019; 14:e0215300. [PMID: 31042743 PMCID: PMC6494040 DOI: 10.1371/journal.pone.0215300] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/30/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is a major public health concern globally, especially in sub-Saharan African countries. Even though determining the incidence of treatment failure and its predictor is a crucial step to reduce the problem, there is limited information indicating the incidence and predictors of treatment failure among children in Ethiopia. Therefore, this study was conducted to assess the incidence and predictors of treatment failure among children on first-line antiretroviral therapy (ART) in Amhara Region referral hospitals, Northwest Ethiopia. METHODS An institution-based retrospective follow-up study was conducted from January 30, 2011, to January 30, 2018. A total of 402 children on first-line antiretroviral therapy were selected with a simple random sampling method in Amhara Region Referral Hospitals, Northwest Ethiopia. Data were extracted by reviewing patients' ART intake and follow-up forms using pretested and structured checklists. The collected data were entered into Epidata Version 4.2 and analysis was done using STATA Version 13. Bivariable and multivariable Cox proportional hazards regression models were fitted to identify predictors of treatment failure. RESULTS A total of 402 records of children on antiretroviral therapy (ART) were reviewed and treatment failures rate within the follow-up period were 12.19% (95% CI: 8.5, 15.88). This study also found that the overall incidence density rate was 3.77% per 100 person-years observation. Virologic failure accounts 48.98% followed by immunologic (28.57%) and mixed failures (22.44%). Poor ART adherence (AHR: 4.6, 95%CI: 1.61, 13.20), drug regimens, AZT-3TC-NVP (AHR: 5.2, 95%CI: 1.9, 14.26), and AZT-3TC-EFV (AHR: 6.26, 95% CI: 1.88, 20.87), Children whose both parent were died (AHR: 2.8, 95%CI: 1.07, 7.37) and world health organization (WHO) clinical stage-4 (AHR: 2.95, 95%CI: 1.04, 8.366) were found to be predictors for treatment failure among children. CONCLUSION The proportion of treatment failure among children on first-line ART in Amhara Region referral hospitals, Northwest Ethiopia was found to be high. Nearly half of the children experienced Virologic failure. Poor ART adherence, children whose parents`died without parents, WHO clinical stage-4 at baseline and type of regimen patients took were found to be predictors of first-line ART treatment failure. Therefore, expanding access to routine viral load, CD4 and clinical monitoring is mandatory to detect and early intervene of treatment failures' to improve outcomes for children on ART. Patient caregivers or parents should strictly support children on medication adherence. Training to health professionals should be given time-based on revised guidelines, and follow up of treatment outcome should be monitored nationally to take the appropriate intervention.
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14
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Chandrasekaran P, Shet A, Srinivasan R, Sanjeeva GN, Subramanyan S, Sunderesan S, Ramesh K, Gopalan B, Suresh E, Poornagangadevi N, Hanna LE, Chandrasekar C, Wanke C, Swaminathan S. Long-term virological outcome in children receiving first-line antiretroviral therapy. AIDS Res Ther 2018; 15:23. [PMID: 30477526 PMCID: PMC6260781 DOI: 10.1186/s12981-018-0208-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/08/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Studies relating to long-term virological outcomes among children on first-line antiretroviral therapy (ART) from low and middle-income countries are limited. METHODS Perinatally HIV infected, ART-naive children, between 2 and 12 years of age, initiating NNRTI-based ART during 2010-2015, with at least 12 months of follow-up, were included in the analysis. CD4 cell counts and plasma HIV-1 RNA were measured every 24 weeks post-ART initiation. Immunologic failure was defined as a decrease in the CD4 count to pre-therapy levels or below and virologic failure as HIV-RNA of > 1000 copies/ml at 48 weeks after ART initiation. Genotypic resistance testing was performed for children with virologic failure. Logistic regression analysis was done to identify predictors of virologic failure. RESULTS Three hundred and ninety-three ART-naïve children living with HIV [mean (SD) age: 7.6 (3) years; mean (SD) CD4%: 16% (8); median (IQR) HIV-RNA: 5.1 (3.5-5.7) log10 copies/ml] were enrolled into the study. At 48 weeks, significant improvement occurred in weight-for-age and height-for-age z-scores from baseline (all p < 0.001). The immunologic response was good; almost 90% of children showing an increase in their absolute CD4+ T cell count to more than 350 cells/mm3. Immunological failure was noted among 11% (28/261) and virologic failure in 29% (94/328) of children. Of the 94 children with virologic failure at 12 months, 36 children showed immunologic failure while the rest had good immunologic improvement. There was no demonstrable correlation between virologic and immunologic failure. 62% had reported > 90% adherence to ART. At the time of virologic failure, multiple NNRTI-associated mutations were observed: 80%-K103N and Y181C being the major NNRTI mutations-observed. Sensitivity (95% CI) of immunologic failure to detect virologic failure was 7% (2-12), specificity 97% (92.4-98.9), PPV 44% (13.7-78.8) and NPV was 72% (65-77.9). There were no statistically significant predictors to detect children who will develop virologic failure on treatment. CONCLUSIONS Considerable immunological improvement is seen in children with ART initiation, but may not be an effective tool to monitor treatment response in the long-term. There is a lack of correlation between immunologic and virologic response while on ART, which may lead to a delay in identifying treatment failures. Periodic viral load monitoring is, therefore, a priority.
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Affiliation(s)
- Padmapriyadarsini Chandrasekaran
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- St Johns Research Institute, Bangalore, India
| | - Ramalingam Srinivasan
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - G. N. Sanjeeva
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - Sudha Subramanyan
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | - Karunaianantham Ramesh
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | - Elumalai Suresh
- Institute of Child Health and Government Hospital for Children, Chennai, India
| | - Navaneethan Poornagangadevi
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - Luke E. Hanna
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | | | - Soumya Swaminathan
- Indian Council of Medical Research, New Delhi, India
- Present Address: World Health Organization, Geneva, Switzerland
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15
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Obiri-Yeboah D, Pappoe F, Baidoo I, Arthur F, Hayfron-Benjamin A, Essien-Baidoo S, Kwakye-Nuako G, Ayisi Addo S. Immunologic and virological response to ART among HIV infected individuals at a tertiary hospital in Ghana. BMC Infect Dis 2018; 18:230. [PMID: 29783953 PMCID: PMC5963173 DOI: 10.1186/s12879-018-3142-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/10/2018] [Indexed: 01/17/2023] Open
Abstract
Background The need to study the outcome of Antiretroviral Therapy (ART) among Human Immunodeficiency Virus (HIV) infected individuals in Ghana, a sub-Saharan African country crucial in the era of the “Treat All” policy. The aim of this study was to analyze selected determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Cape Coast, Ghana. Methods An analytical cross sectional study with a retrospective component was conducted in the Cape Coast Teaching Hospital (CCTH), Central Region. Clients aged 18 years and above attending the HIV Clinics for ART and who were on ART for 6 months or more were recruited. The viral loads, CD4 count and other socio-demographic data were analyzed using STATA version 13 (STATA Corp, Texas USA). Descriptive analysis was done and presented with appropriate measures of central tendencies. In addition, bivariate and multivariate analysis was carried out with p value of 0.05 interpreted as evidence of association between variables. Results A total of 440 participants were included in this study with a mean age of 45.5 (±11.6) years. The mean CD4 count at baseline, 6 months on ART and currently at study recruitment were 215.1 cells/mm3 (±152.6), 386.6 cells/mm3 (±178.5), and 579.6 cells/mm3 (±203.0) respectively. After 6 months and 12 months on ART, the number who had achieved viral copies < 1000/ml were 149 (47.0%) and 368 (89.6%) respectively. There was strong evidence of an association between having CD4 count < 350 cells/mm3 after 6 months on ART and having a diagnosis of tuberculosis since HIV diagnosis (aOR 8.5, 95% CI 1.1–73.0, p = 0.05) and clients having plasma viral load > 1000 copies/ml after 6 months on ART (aOR 2.0, 95% CI 1.2–3.2, p = 0.01). Conclusion There was good response to ART among clients, high virological suppression and immunological recovery hence low rates of change to second line ART regimen in this cohort studied. With strict adherence to the national policy on HIV testing, management of positive clients and full implementation of the “Treat All” policy, Ghana could achieve, if nothing at all, the third “90, 90, 90” target by 2020. Electronic supplementary material The online version of this article (10.1186/s12879-018-3142-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Faustina Pappoe
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ibrahim Baidoo
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Francis Arthur
- Microbiology Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Anna Hayfron-Benjamin
- Department of Maternal and Child Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Essien-Baidoo
- Department of Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Godwin Kwakye-Nuako
- Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
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Mossoro-Kpinde CD, Gody JC, Mboumba Bouassa RS, Mbitikon O, Jenabian MA, Robin L, Matta M, Zeitouni K, Longo JDD, Costiniuk C, Grésenguet G, Touré Kane NC, Bélec L. High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic: A cross-sectional study. Medicine (Baltimore) 2017; 96:e6282. [PMID: 28272247 PMCID: PMC5348195 DOI: 10.1097/md.0000000000006282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
A large cohort of 220 HIV-1-infected children (median [range] age: 12 [4-17] years) was cared and followed up in the Central African Republic, including 198 in 1st-line and 22 in 2nd-line antiretroviral regimens. Patients were monitored clinically and biologically for HIV-1 RNA load and drug resistance mutations (DRMs) genotyping. A total of 87 (40%) study children were virological responders and 133 (60%) nonresponders. In children with detectable viral load, the majority (129; 97%) represented a virological failure. In children receiving 1st-line regimens in virological failure for whom genotypic resistance test was available, 45% displayed viruses harboring at least 1 DRM to NNRTI or NRTI, and 26% showed at least 1 major DRM to NNRTI or NRTI; more than half of children in 1st-line regimens were resistant to 1st-generation NNRTI and 24% of the children in 1st-line regimens had a major DRMs to PI. Virological failure and selection of DRMs were both associated with poor adherence. These observations demonstrate high rate of virological failure after 3 to 5 years of 1st-line or 2nd-line antiretroviral treatment, which is generally associated with DRMs and therapeutic failure. Overall, more than half (55%) of children receiving 1st-line antiretroviral treatment for a median of 3.4 years showed virological failure and antiretroviral-resistance and thus eligible to 2nd-line treatment. Furthermore, two-third (64%) of children under 2nd-line therapy were eligible to 3rd-line regimen. Taken together, these observations point the necessity to monitor antiretroviral-treated children by plasma HIV-1 RNA load to diagnose as early as possible the therapeutic failure and operate switch to a new therapeutic line.
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Affiliation(s)
| | - Jean-Chrysostome Gody
- Faculté des Sciences de la Santé, Université de Bangui
- Complexe Pédiatrique, Bangui, Central African Republic
| | - Ralph-Sydney Mboumba Bouassa
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | | | - Mohammad-Ali Jenabian
- Département des Sciences Biologiques et Centre de Recherche BioMed, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Leman Robin
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Mathieu Matta
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Kamal Zeitouni
- Saint Georges Hospital University Medical Center, Université de Balamand, Beirut, Lebanon
| | - Jean De Dieu Longo
- Faculté des Sciences de la Santé, Université de Bangui
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Central African Republic
| | - Cecilia Costiniuk
- Chronic Viral Illnesses Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montréal
| | - Gérard Grésenguet
- Faculté des Sciences de la Santé, Université de Bangui
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Central African Republic
| | - Ndèye Coumba Touré Kane
- Laboratoire de Bactériologie Virologie, Hôpital Aristide Le Dantec, Dakar and Université Cheikh Anta Diop de Dakar, Sénégal
| | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
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