HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study

Abstract

Background Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana. Methods A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression. Results The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04–6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58–15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92–126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58–1.15], p = 0.005). Conclusion The prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.

Predictors of unsuppressed viral load among adults on follow up of antiretroviral therapy at selected public and private health facilities of Adama town: unmached case-control study

“…However, this study is not similar with the study conducted in Weliso town of Oromia, Ethiopia, Vietnam and Ghana in which adherence level had no statistically significant association [28][29][30]. The reason for the variation might be the difference in the method of data This study is similar with the study conducted in South Africa and Amhara regional hospitals in which CPT users were one of the independent predictors of virological failure or non suppressed viral among patients on follow up of first line ART treatment [31,32].…”

Virological failure of first-line antiretroviral therapy in children living with HIV in Indonesia and associated factors

“…In subjects treated with nevirapine, the proportion of failure was much higher compared to those treated with efavirenz, but still comparable to findings of other studies reporting virological failure. 18,19 However, univariate analysis of first-line backbone regimens showed no statistically significant differences in hazard ratios.…”

“…9,15 Several factors that are known to increase the risk of virological failure on CLHIV include younger age at diagnosis or treatment initiation, WHO stage 3 and 4, lower CD4 count, nevirapine (NVP)-based regimen, and treatment interruption. 10,11,[16][17][18][19][20][21] This study aimed to determine the incidence of treatment failure with first-line ART in situations of limited VL monitoring in Indonesia, as well as to identify the predictors of treatment failure in order to assist clinicians in monitoring their patients more closely.…”

Effectiveness of a community-based intervention (Konga model) to address the factors contributing to viral load suppression among children living with HIV in Tanzania: a cluster-randomized clinical trial protocol

“…Opportunistic infections, such as TB, have been shown to hamper VLS in children receiving ART [ 14 , 19 , 20 , 38 ]. Another study demonstrated that the initiation of ART in children reduces the incidence of TB [ 24 ].…”