Rates and Correlates of Short Term Virologic Response among Treatment-Naïve HIV-Infected Children Initiating Antiretroviral Therapy in Ethiopia: A Multi-Center Prospective Cohort Study

Abstract

There is limited data on virologic outcome and its correlates among HIV-infected children in resource-limited settings. We investigated rate and correlates of virologic outcome among treatment naïve HIV-infected Ethiopian children initiating cART, and were followed prospectively at baseline, 8, 12, 24 and 48 weeks using plasma viral load, clinical examination, laboratory tests and pretreatment HIV drug resistance (PDR) screening. Virologic outcome was assessed using two endpoints–virological suppression defined as having “undetectable” plasma viral load < 150 RNA copies/mL, and rebound defined as viral load ≥150 copies/mL after achieving suppression. Cox Proportional Hazards Regression was employed to assess correlates of outcome. At the end of follow up, virologic outcome was measured for 110 participants. Overall, 94(85.5%) achieved virological suppression, of which 36(38.3%) experienced virologic rebound. At 48 weeks, 9(8.2%) children developed WHO-defined virological treatment failure. Taking tenofovir-containing regimen (Hazard Ratio (HR) 3.1-[95% confidence interval (95%CI) 1.0–9.6], p = 0.049) and absence of pretreatment HIV drug resistance (HR 11.7-[95%CI 1.3–104.2], p = 0.028) were independently associated with earlier virologic suppression. In conclusion, PDR and cART regimen type correlate with rate of virologic suppression which was prominent during the first year of cART initiation. However, the impact of viral rebound in 38.3% of the children needs evaluation.

Determinants of Immunovirological Response among Children and Adolescents Living with HIV-1 in the Central Region of Cameroon

“…This result could be explained by the predominance of the age groups 6 to 9 years (in children) and 10 to 15 years (in adolescents). Our results are similar to those of a study conducted by Fokam et al at the Health Centre of the National Social Security Fund in Yaoundé, Cameroon, which found a median (IQR) age of 13 (11–16) years among adolescents, and the study conducted by Tadesse et al in Ethiopia, who found a median age of 9 (5–12) years among the population aged 3 to 12 years [ 8 , 15 ].…”

“…Of note, suboptimal adherence to treatment is known as a major determinant of ART failure among children in Cameroon [ 16 ]. In effect, a suboptimal adherence level is a major challenge often reported in children and adolescents due to a lack of psychological support and close monitoring by tutors and clinicians [ 12 , 13 , 14 , 15 , 16 , 17 , 19 ]. In our present study, adherence was measured by self-reporting, which is a method with possible recall bias from clients.…”

“…Lack of adherence and of provision of adequate psychological support in children and adolescents has been reported to represent the main cause of loss to follow-up and virologic failure [ 26 , 27 ]. Non-adherence could be due to supply disruptions, more limited access to paediatric antiretroviral molecules or difficulties with therapeutic formulation [ 5 , 15 ]. Our results are very low compared with the study conducted in children by Teasdale et al, who found 84.0% viral suppression after two years of antiretroviral treatment, and the study conducted in adolescents by Fokam et al, who found 71% viral suppression after seven years of antiretroviral treatment [ 8 , 14 ].…”

Predictors of Efavirenz Plasma Exposure, Auto-Induction Profile, and Effect of Pharmacogenetic Variations among HIV-Infected Children in Ethiopia: A Prospective Cohort Study

“…However, children were far from the UNAIDS 90-90-90 goals, were not getting optimum treatment, and had lower rates of viral suppression than adults [1, 3,4]. Recently we reported poor viral suppression [5,6], high rates of viral drug resistance [7,8], and treatment-associated adverse events [9,10] among HIV-infected Ethiopian children.…”

Safety and efficacy of abacavir for treating infants, children, and adolescents living with HIV: a systematic review and meta-analysis

“…Two (8%) studies were comparative RCTs 13,20 and one (4%) was a singlearm, phase 2 trial 21 with abacavir used as backbone. 12 (50%) were prospective cohort studies, 15,[22][23][24][25][26][27][28][29][30][31][32] including one cohort nested in an RCT. 22 Seven (29%) were retrospective cohort studies 14,[33][34][35][36][37][38] and two (8%) were crosssectional surveys.…”