BACKGROUND: Long-term (>12 months follow-up) virologic data of children receiving antiretroviral therapy (ART) in Sub-Saharan Africa are limited. Data from rural areas are especially scarce. The aim of this study was to evaluate the long-term virologic outcome of a pediatric cohort in rural South Africa. METHODS: We performed a retrospective, observational cohort study, including children who initiated ART at least 1 year before data-analysis. Regular monitoring, including HIV-RNA testing, was performed. Genotypic resistance testing was done for children with virologic failure (HIV-RNA >1000 copies/mL). Logistic regression analysis was used to determine predictors of virologic failure. RESULTS: A total of 101 children were included. Median duration since beginning ART was 31 months. Overall patient retention-rate was 76% (77/101), with early mortality being the main cause of attrition (13/24, 54%). Initial immunologic and virologic responses were excellent. However, 38% (31/81) of children subsequently experienced virologic failure. Correlation between virologic failure and immunologic decline was nearly absent. At the time of failure, multiple non-nucleoside reverse transcription inhibitor-associated mutations were observed in 52% (12/23) of children. No definite predictors of virologic failure could be determined. CONCLUSIONS: ART provides significant benefits for children in this rural African setting, but the finding that a large proportion of children had virologic failure and developed major drug-resistance mutations on first-line ART is worrying. Causes of failure need to be analyzed and effective prevention strategies are needed. Because of the lack of a correlation between immunologic and virologic failure, treatment failure generally stays unnoticed in settings where HIV-RNA testing is not available.
BACKGROUND: Long-term (>12 months follow-up) virologic data of children receiving antiretroviral therapy (ART) in Sub-Saharan Africa are limited. Data from rural areas are especially scarce. The aim of this study was to evaluate the long-term virologic outcome of a pediatric cohort in rural South Africa. METHODS: We performed a retrospective, observational cohort study, including children who initiated ART at least 1 year before data-analysis. Regular monitoring, including HIV-RNA testing, was performed. Genotypic resistance testing was done for children with virologic failure (HIV-RNA >1000 copies/mL). Logistic regression analysis was used to determine predictors of virologic failure. RESULTS: A total of 101 children were included. Median duration since beginning ART was 31 months. Overall patient retention-rate was 76% (77/101), with early mortality being the main cause of attrition (13/24, 54%). Initial immunologic and virologic responses were excellent. However, 38% (31/81) of children subsequently experienced virologic failure. Correlation between virologic failure and immunologic decline was nearly absent. At the time of failure, multiple non-nucleoside reverse transcription inhibitor-associated mutations were observed in 52% (12/23) of children. No definite predictors of virologic failure could be determined. CONCLUSIONS: ART provides significant benefits for children in this rural African setting, but the finding that a large proportion of children had virologic failure and developed major drug-resistance mutations on first-line ART is worrying. Causes of failure need to be analyzed and effective prevention strategies are needed. Because of the lack of a correlation between immunologic and virologic failure, treatment failure generally stays unnoticed in settings where HIV-RNA testing is not available.
Authors: Benjamin P Westley; Allison K DeLong; Chhraing S Tray; Dim Sophearin; Elizabeth M Dufort; Eric Nerrienet; Leeann Schreier; Joseph I Harwell; Rami Kantor Journal: Clin Infect Dis Date: 2012-04-26 Impact factor: 9.079
Authors: Claudia S Crowell; Almoustapha I Maiga; Mariam Sylla; Babafemi Taiwo; Niaboula Kone; Assaf P Oron; Robert L Murphy; Anne-Geneviève Marcelin; Ban Traore; Djeneba B Fofana; Gilles Peytavin; Ellen G Chadwick Journal: Pediatr Infect Dis J Date: 2017-11 Impact factor: 2.129
Authors: Nellie Wadonda-Kabondo; Diane Bennett; Joep J van Oosterhout; Kundai Moyo; Mina Hosseinipour; Josh Devos; Zhiyong Zhou; John Aberle-Grasse; Thomas R Warne; Clement Mtika; Ben Chilima; Richard Banda; Olesi Pasulani; Carol Porter; Sam Phiri; Andreas Jahn; Debbie Kamwendo; Michael R Jordan; Storn Kabuluzi; Frank Chimbwandira; Mathew Kagoli; Blackson Matatiyo; Austin Demby; Chunfu Yang Journal: Clin Infect Dis Date: 2012-05 Impact factor: 9.079
Authors: Peter K Olds; Julius P Kiwanuka; Denis Nansera; Yong Huang; Peter Bacchetti; Chengshi Jin; Monica Gandhi; Jessica E Haberer Journal: AIDS Care Date: 2014-12-06