Weight as Predictors of Clinical Progression and Treatment Failure

Kariminia, Azar; Durier, Nicolas; Jourdain, Gonzague; Saghayam, Suneeta; Chau, Viet; Nguyen, Lam Van; Hansudewechakul, Rawiwan; Lumbiganon, Pagakrong; Chokephaibulkit, Kulkanya; Truong, Khanh Huu; Sirisanthana, Virat; Vibol, Ung; Saphonn, Vonthanak; Ananworanich, Jintanat; Yusoff, Nik Khairulddin Nik; Kurniati, Nia; Razali, Kamarul Azahar Mohd; Fong, Moy Siew; Nallusamy, Revathy; Wati, Dewi Kumara

doi:10.1097/qai.0000000000000227

Cited by 8 publications

(3 citation statements)

References 23 publications

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“…Wasting has been a significant complication of HIV infection since early in the epidemic [25,26], and remains an important clinical problem, particularly among children and adolescents living in Asian and African countries [27,28]. Although there are no studies demonstrating the adverse consequences of wasting on VR, it is well-documented that low weight-for-age has been significantly correlated with clinical and immunologic failure in children and adolescents [27,29]. Unfortunately, in our analysis, we did not include incident opportunistic infections (OIs).…”

Section: Discussionmentioning

confidence: 99%

Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy

Sudjaritruk

Aurpibul

et al. 2017

Journal of Adolescent Health

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Purpose To assess the incidence and predictors of post-suppression virologic rebound (VR) among adolescents on stable combination antiretroviral therapy (cART) in Asia. Methods Perinatally HIV-infected Asian adolescents (10-19 years) with documented virologic suppression [two consecutive viral loads (VL) <400 copies/ml >6 months apart] were included. Baseline was the date of the first VL <400 copies/ml at age >10 years, or the 10th birthday for those with prior suppression. Cox proportional hazards models were used to identify predictors of post-suppression VR (VL >1000 copies/ml). Results Of 1379 eligible adolescents, 47% were males. At baseline, 22% were receiving protease inhibitor (PI)-containing regimens; median CD4 cell count (IQR) was 685 (448-937) cells/mm3; 2% had pre-adolescent virologic failure (VF) before subsequent suppression. During adolescence, 180 individuals (13%) experienced post-suppression VR at a rate of 3.4 (95%CI: 2.9-3.9) per 100 person-years, which was consistent over time. Median time to VR during adolescence (IQR) was 3.3 (2.1-4.8) years. Wasting (weight-for-age z-score <-2.5), being raised by grandparents, receiving second-line PI-based regimens, starting cART after 2005, and having pre-adolescent VF were independent predictors of adolescent VR. At VR, median age, CD4 cell count, and VL (IQR) were 14.8 (13.2-16.4) years, 507 (325-723) cells/mm3, and 4.1 (3.5-4.7) log10 copies/ml, respectively. Conclusions A modest and consistent incidence of post-suppression VR was documented during adolescence in our cohort. Having poor weight, receiving second-line regimens, and prior VF were associated with an increased VR rate. Adolescents at higher risk of VR may benefit from more intensive VL monitoring to enhance adherence management.

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Section: Discussionmentioning

confidence: 99%

Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy

Sudjaritruk

Aurpibul

et al. 2017

Journal of Adolescent Health

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“…This could be because of the small number of children who were reported to have the conditions and most children had already been started on cotrimoxazole prophylactic therapy. However, several other studies have reported that these variables are associated with malnutrition in HIV infected patients [22, 26, 30]. Cotrimoxazole prophylactic therapy has been shown to improve their survival in children [31]; and improvement in anthropometric Z-scores among adults [32].…”

Section: Discussionmentioning

confidence: 99%

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

et al. 2016

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BackgroundAntiretroviral therapy (ART) is a lifesaving intervention for HIV infected children. There is a scarcity of data on immunological recovery and its relation with growth indicators among HIV infected young children. The current study aims to assess the pattern of anthropometric Z-score improvement following initiation of first-line ART among under-five children and the relationship between anthropometric Z-score improvement and immunologic recovery.MethodsWe included under-five children who were on first-line ART at five major hospitals in Addis Ababa, Ethiopia. We measured anthropometry and collected clinical and laboratory data at follow up, and we retrieved clinical and anthropometric data at ART initiation from records. Z-scores for each of the anthropometric indices were calculated based on WHO growth standards using ENA for SMART 2011 software. Linear regression was used to assess the relationship between time on ART and anthropometric Z-score improvement; and the relationship between anthropometric Z-score improvement and immunologic recovery. Multiple linear regression was used to assess the independent predictors of anthropometric Z-score change.ResultsThe median age of the participants was 4.1 (Interquartile range (IQR): 3.3–4.9) years. More than half (52.48%) were female. The median duration of follow up was 1.69 (IQR: 1.08–2.63) years. There was a significant improvement in all anthropometric indices at any follow up after initiation of first-line ART (underweight; 39.5% vs16.5%, stunting; 71.3% vs 62.9% and wasting; 16.3% vs 1.0%; p-value< 0.0001). There was an inverse relationship between improvement in weight for age Z-score (WAZ) and duration of ART (R2 = 0.04; F (1, 158); p = 0.013). Height for age Z-score (HAZ) both at the time of ART initiation and follow up has a positive linear relationship with CD4 percentage at follow up (Coef. = 1.92; R2 = 0.05; p-value = 0.002). Duration on ART (Std. Err. = 0.206, t = -1.99, p-value = 0.049) and level of maternal education (Std. Err. = 0.290, t = 2.64, p-value = 0.009) were the only independent predictors of the change in WAZ and change in HAZ at any follow up visit respectively.ConclusionThere was a significant improvement in all anthropometric indices at any follow-up after initiation of first-line ART among under-five children. HAZ was linearly related with immunologic recovery following ART initiation. The findings indicate that anthropometric indices could be taken as proxy indicators of immunologic recovery for under-five children.

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“…Malnutrition increases hospitalisation and mortality in HIV-infected children [ 43 – 45 ], but few associations with immunological failure exist [ 39 , 46 ] and none with virological failure on ART [ 39 , 47 ]. There further appears to be no literature about toxicity, other adverse effects, or the ART regimen of choice in severely malnourished children [ 48 ] and very few studies have assessed the effect of pharmacokinetics of ART specifically in malnourished children [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Development of Drug Resistance Mutations in HIV-1 Infected Children Failing Protease Inhibitor-Based Antiretroviral Therapy in South Africa

et al. 2015

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ObjectiveLimited data are available from the developing world on antiretroviral drug resistance in HIV-1 infected children failing protease inhibitor-based antiretroviral therapy, especially in the context of a high tuberculosis burden. We describe the proportion of children with drug resistance mutations after failed protease inhibitor-based antiretroviral therapy as well as associated factors.MethodsData from children initiated on protease inhibitor-based antiretroviral therapy with subsequent virological failure referred for genotypic drug resistance testing between 2008 and 2012 were retrospectively analysed. Frequencies of drug resistance mutations were determined and associations with these mutations identified through logistic regression analysis.ResultsThe study included 65 young children (median age 16.8 months [IQR 7.8; 23.3]) with mostly advanced clinical disease (88.5% WHO stage 3 or 4 disease), severe malnutrition (median weight-for-age Z-score -2.4 [IQR -3.7;-1.5]; median height-for-age Z-score -3.1 [IQR -4.3;-2.4]), high baseline HIV viral load (median 6.04 log10, IQR 5.34;6.47) and frequent tuberculosis co-infection (66%) at antiretroviral therapy initiation. Major protease inhibitor mutations were found in 49% of children and associated with low weight-for-age and height-for-age (p = 0.039; p = 0.05); longer duration of protease inhibitor regimens and virological failure (p = 0.001; p = 0.005); unsuppressed HIV viral load at 12 months of antiretroviral therapy (p = 0.001); tuberculosis treatment at antiretroviral therapy initiation (p = 0.048) and use of ritonavir as single protease inhibitor (p = 0.038). On multivariate analysis, cumulative months on protease inhibitor regimens and use of ritonavir as single protease inhibitor remained significant (p = 0.008; p = 0.033).ConclusionMajor protease inhibitor resistance mutations were common in this study of HIV-1-infected children, with the timing of tuberculosis treatment and subsequent protease inhibitor dosing strategy proving to be important associated factors. There is an urgent need for safe, effective, and practicable HIV/tuberculosis co-treatment in young children and the optimal timing of treatment, optimal dosing of antiretroviral therapy, and alternative tuberculosis treatment strategies should be urgently addressed.

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Weight as Predictors of Clinical Progression and Treatment Failure

Cited by 8 publications

References 23 publications

Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy

Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

Factors Associated with the Development of Drug Resistance Mutations in HIV-1 Infected Children Failing Protease Inhibitor-Based Antiretroviral Therapy in South Africa

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