Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

Abstract

Background Human immunodeficiency virus (HIV) infected children represent a very vulnerable population for anti-retroviral therapy (ART) drug resistance. As a global target, 90% of patients receiving ART should have HIV-RNA viral suppression. A threshold of > 1000 RNA copies/ml is used to define non-suppressed viral load. If it is confirmed in the laboratory, adherence should be addressed and should be followed by the switch to second-line ART. Therefore, the aim of this study was to assess the rate of viral load suppression among children tested at the Amhara Public Health Institute (APHI), Bahir Dar. Methods Institutional based cross-sectional study design was conducted from July 01, 2017 to June 30, 2018, in children under the age of 15 years. Socio-demographic, clinical and HIV1RNA viral load data were collected from the excel database. The data were analyzed in SPSS 20.0 statistical software. Results A total of 1567 children, age ranged from one to 14 years, were tested for HIV viral load. Of which, about 54% were males. Children were treated using nevirapine-based (76.7%), efavirenz-based (21.8%) and protease inhibitor-based (1.5%) anti-retroviral drugs. Non-suppressed HIV viral load was found in 28.3% of the participants. High viral load (> 1000 cp/ml) were found in 24% of the children below the age of five years. Children on nevirapine-based treatment had about two times more non-suppressed viral load (Adjusted odds ratio [AOR]: 1.90; 95%CI: 1.41–2.56; P < 0.001) compared to those who had efavirenz-based treatment. However, adherence (P: 0.204) was not associated with non-suppressed viral load. Conclusions There was a high rate of non-suppressed HIV viral load among children tested at APHI. Specifically, the odds of having a non-suppressed viral load was higher in NVP based treatment users. Hence, comprehensive management and follow up of children on ART, and testing for resistance as well as viral load could help to reduce the problem in advance.

High rate of loss to follow-up and virological non-suppression in HIV-infected children on antiretroviral therapy highlights the need to improve quality of care in South Africa

“…Among children who had a recent viral load, almost one-third of children experienced virological non-suppression in their first years on ART. This corresponds with recent studies (2017-2019) from low-and middle-income countries (LMICs) (28-38%) (5,(17)(18)(19)(20)(21)(22). However, two systematic reviews (both 20%) (22,23) and other studies have found lower proportions of virological non-suppression in children, including 12% in Ethiopia (6), 18% in South Africa (15) and 20% in Thailand (24).…”

Long-Term Immunological and Virological Outcomes in Children Receiving Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia

“…Nevirapine-based regimen was significantly associated with virological and immunological failure compared to those children who were on EFV-based treatment (AOR = 1:90, (1.41-2.56), P = 0:001) or which is 2 times higher in virological and immunological failure than EFVbased treatment. Consistent findings were reported from Tanzania (AOR = 4:1, (1.6-10.4), P = 0:003) [39], Uganda [41], and Bahir Dar, Ethiopia (AOR = 1:90, 95% CI: 1.41-2.56, P = 0:001) [24]. Contrasting finding from our study was reported from Asella, Ethiopia [42] that indicated HAART regimen variability was not significantly associated Journal of Immunology Research with recovery of CD4 counts and viral load failure, Addis Ababa, Ethiopia [43] and in Uganda study [44].…”

“…In the current study, we assessed the rate of viral load suppression, immunological response failure, and hematological abnormalities among children receiving HAART at Hawassa University ART Clinic for the reason that identification of such problems is essential to make interventions during drug and disease management among children receiving HAART for a prolonged duration of time [24].…”

Virological failure and antiretroviral resistance among HIV-infected children after five years follow-up in the ANRS 12225-PEDIACAM cohort in Cameroon

“…Other factors including poor adherence, age of patients, limited access to drug formulations adapted to paediatric needs, and treatment duration could be associated with VF. Also, younger age could be an additional factor related to VF in the Pediacam cohort when participants are aged less than 6 years as reported by other studies in Ethiopia and Kenya [ 22 , 23 ].…”