Prevalence and Determinants of Virological Failure in HIV-Infected Children on Antiretroviral Therapy in Rural Cameroon: A Cross-Sectional Study

Zoufaly, Alexander; Fillekes, Quirine; Hammerl, Raffaela; Nassimi, Nilofar; Jochum, Johannes; Drexler, Jan Felix; Awasom, Charles; Sunjoh, Frida; Burchard, Gerd; Burger, David M.; Lunzen, Jan van; Feldt, Torsten

doi:10.3851/imp2562

Cited by 44 publications

(60 citation statements)

References 47 publications

(57 reference statements)

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“…Our finding was in line with study conducted in Cameron [28] and in Gondar, Ethiopia [26] showed long time duration of treatment to be one of determinant factors for treatment failure.…”

Section: Sensitivity (%) Specificity (%) Ppv (%) Npv (%)supporting

confidence: 92%

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Brhane¹,

Nibret²,

Abay³

2017

J AIDS Clin Res

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Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients. Objective:The aim at this study was to assess the prevalence of HIV/AIDS treatment failure and its determinants factors of patients on first line HAART at Felegehiwot Referral Hospital. Methods:Cross sectional study was conducted on 421 participants who had started first line HAART during August 2016 to September 2016. Data were collected from patients' chart starting from ART commencement and face to face interview using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were enter in to EPI info version 3.5.1 and transfer to and analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, positive and negative predictive values, life table, receiver operating characteristics curves, bi-variate and multiple logistic regression were used to analysis. Independent associations were considered with p<0.05.Result: Among the 421 participants enrolled, 292 (69.4%) were adult and 129 (30.6%) were children. More than half 243 (57.7%) of the participants were females. The adult median age at ART initiation was 38.0 years with inter quartile rage (IQR) 10 and for children 9.8 years with IQR 4.The median duration of treatment failure from initiation of treatment was 87 months (IQR 110-65 months). A total of 45 (10.7%) participants were found to have treatment failure. The median CD4 T-cells at initiation of Anti retroviral therapy were 147 cells/µl (IQR 226-84.5). The median time to detect virological failure was 47 months. Sensitivity of immunologic failure of predicting virological failure was 62.2%. Clinical stage II 374 (88.8%) was the predominant clinical stage. Conclusion:The prevalence of treatment failure in this study was 10.7%. Long duration on treatment, conducting faith healing, immunologic failure, high medication dosage, and ambulatory functional status at baseline and not feeling privacy during consultation and counseling were found to be significant predictors of treatment failure.Therefore early identification of associated factors and monitoring treatment failure has to be strengthened to benefit patients from prevent further complication.

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“…Our finding was in line with study conducted in Cameron [28] and in Gondar, Ethiopia [26] showed long time duration of treatment to be one of determinant factors for treatment failure.…”

Section: Sensitivity (%) Specificity (%) Ppv (%) Npv (%)supporting

confidence: 92%

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Brhane¹,

Nibret²,

Abay³

2017

J AIDS Clin Res

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“…A study conducted in Cameroon showed that risk of virological failure was substantially increased if the child's mother had already died [14]. Sebunya et al found that Ugandan children who never experienced ART failure were more likely to have a grandmother as their primary caregiver and suggest that grandparents often reside in rural settings and have more time to offer care to the children, facilitating adherence [16].…”

Section: Resultsmentioning

confidence: 97%

“…When patients initiating ART fail to achieve viral suppression by 24 weeks of treatment, the possibility of suboptimal adherence and other factors must be considered. Treatment failure, as measured by detectable viral load (VL) during chronic care, has been shown to be associated with non-adherence [14][15][16], although this has not been consistently observed [17]. In a study from Zambia, Haberer et al demonstrated that older children (9-15 years) who were unaware of their HIV diagnosis were at risk of treatment failure due to poor adherence [18].…”

Section: Resultsmentioning

confidence: 98%

“…Stigma and discrimination can contribute to non-adherence and non-disclosure, thereby potentially increasing the risk of treatment failure. There is a need for more psychosocial human resources in order to elucidate the importance of appropriate treatment adherence in children and adolescents and the impact of their caregivers on treatment outcomes [14]. As recommended by a recent study on African youths, high scores on the pediatric symptom checklist can predict poor adherence and treatment failure before poor outcomes are recognizable [20].…”

Section: Resultsmentioning

confidence: 99%

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Tackling virological failure in HIV-infected children living in Africa

Jenabian

Costiniuk

Bouassa

et al. 2015

Expert Review of Anti-infective Therapy

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Drug resistance in HIV-infected children is one of the main contributors to antiretroviral treatment (ART) failure, especially in developing countries. Sub-Saharan Africa has the largest burden of pediatric HIV infection in the world. Herein, we systematically review the current status of ART failure in HIV-infected African children. A literature search for publications within 10 years was performed through PubMed to identify relevant articles. Included studies examined the impact of timing of ART initiation, criteria for diagnosing therapeutic failure, predictors of therapeutic failure, management strategies and future directions to minimize failure rates in these pediatric populations. Although there is scale-up of ART programs in Africa, novel therapeutic and management strategies are needed to overcome current challenges.

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“…Its continued positive clinical impact depends on taking more than 95% of prescribed doses (Jobanputra et al, 2015;WHO, 2013;Zoufaly et al, 2013;Bhattacharya & Dubey, 2011;MOH, 2007). Several factors affect the rate of treatment adherence among children including drug regimen, caregivers, and society and culture related factors (Castro, Gonzalez, & Perez, 2015;Haberer & Mellins, 2009) (Hagstromer, Lundstedt, Balcha, & Bjorkman, 2013;Muller et al, 2011), (Reda & Biadgilign, 2012).…”

Section: Introductionmentioning

confidence: 99%

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

Biru

Jerene²,

Lundqvist

et al. 2016

AIDS Care

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Prevalence and Determinants of Virological Failure in HIV-Infected Children on Antiretroviral Therapy in Rural Cameroon: A Cross-Sectional Study

Abstract: This study demonstrates high virological failure rates and a high variability of NVP plasma levels among HIV-infected children in a routine ART programme in rural Cameroon. Strategies to improve adherence to ART in HIV-infected children are urgently needed.

Cited by 44 publications

References 47 publications

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Tackling virological failure in HIV-infected children living in Africa

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

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