K Anderson1, R Muloiwa, M-A Davies. 1. Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. kimanderson@law.co.za.
Abstract
BACKGROUND: The burden of paediatric HIV in South Africa has shifted to older children and adolescents. Nevertheless, information on long-term treatment outcomes of perinatally HIV-infected (PHIV) children is limited. OBJECTIVES: To examine long-term immunological and virological outcomes of children who were in care for at least 10 years after starting antiretroviral therapy (ART). METHODS: We performed a retrospective cohort study of 127 PHIV children who initiated ART at a Cape Town clinic between 2002 and 2005 and were followed up for ≥10 years from the ART initiation date. CD4+ counts and viral loads (VLs) were analysed for each successive year on ART. Treatment history, resistance test results, growth data, hospital admissions and opportunistic infection history were described. RESULTS: The median age at ART initiation was 2.6 years (interquartile range (IQR) 1.3 - 4.9) and the median CD4+ percentage 13.0% (IQR 8.9 - 18.0). The first ART regimen was non-nucleoside reverse transcriptase inhibitor based (63.8%) or protease inhibitor based (36.2%). Median follow-up was 12.2 years (IQR 11.1 - 13.0). At the last assessment, 49.6% of patients were on first-line and 43.3% on second-line ART. At the last assessment, the median CD4+ count was 686 cells/µL (IQR 545 - 859) and 78.7% of children had CD4+ counts >500 cells/µL (92.1% of those on first-line v. 70.9% on second-line ART; p=0.003). At the last assessment, 79.5% of patients were virally suppressed (VL <400 copies/mL), 86.2% of those on first-line v. 76.8% on second-line ART (p=0.183). The 10-year probability of experiencing viral failure (VF) was 56.7% (95% confidence interval (CI) 48.3 - 65.5) and the 10-year probability of switching to second-line ART 45.7% (95% CI 37.5 - 54.8). The probability of experiencing VF between the ages of 10 and 18 years was 37.4% (95% CI 25.4 - 52.8). CONCLUSIONS: Virological and immunological outcomes were good overall in PHIV children who remained in care for ≥10 years at this clinic, but >40% of children were on second-line ART with poorer immunological outcomes.
BACKGROUND: The burden of paediatric HIV in South Africa has shifted to older children and adolescents. Nevertheless, information on long-term treatment outcomes of perinatally HIV-infected (PHIV) children is limited. OBJECTIVES: To examine long-term immunological and virological outcomes of children who were in care for at least 10 years after starting antiretroviral therapy (ART). METHODS: We performed a retrospective cohort study of 127 PHIV children who initiated ART at a Cape Town clinic between 2002 and 2005 and were followed up for ≥10 years from the ART initiation date. CD4+ counts and viral loads (VLs) were analysed for each successive year on ART. Treatment history, resistance test results, growth data, hospital admissions and opportunistic infection history were described. RESULTS: The median age at ART initiation was 2.6 years (interquartile range (IQR) 1.3 - 4.9) and the median CD4+ percentage 13.0% (IQR 8.9 - 18.0). The first ART regimen was non-nucleoside reverse transcriptase inhibitor based (63.8%) or protease inhibitor based (36.2%). Median follow-up was 12.2 years (IQR 11.1 - 13.0). At the last assessment, 49.6% of patients were on first-line and 43.3% on second-line ART. At the last assessment, the median CD4+ count was 686 cells/µL (IQR 545 - 859) and 78.7% of children had CD4+ counts &gt;500 cells/µL (92.1% of those on first-line v. 70.9% on second-line ART; p=0.003). At the last assessment, 79.5% of patients were virally suppressed (VL &lt;400 copies/mL), 86.2% of those on first-line v. 76.8% on second-line ART (p=0.183). The 10-year probability of experiencing viral failure (VF) was 56.7% (95% confidence interval (CI) 48.3 - 65.5) and the 10-year probability of switching to second-line ART 45.7% (95% CI 37.5 - 54.8). The probability of experiencing VF between the ages of 10 and 18 years was 37.4% (95% CI 25.4 - 52.8). CONCLUSIONS: Virological and immunological outcomes were good overall in PHIV children who remained in care for ≥10 years at this clinic, but &gt;40% of children were on second-line ART with poorer immunological outcomes.
Authors: Kayla Somerville; Cathy A Jenkins; James G Carlucci; Anna K Person; Daisy M Machado; Marco T Luque; Jorge A Pinto; Vanessa Rouzier; Ruth K Friedman; Catherine C McGowan; Bryan E Shepherd; Peter F Rebeiro Journal: J Acquir Immune Defic Syndr Date: 2021-07-01 Impact factor: 3.771
Authors: Amy Price; Grace McHugh; Victoria Simms; Robina Semphere; Lucky G Ngwira; Tsitsi Bandason; Hilda Mujuru; Jon O Odland; Rashida A Ferrand; Andrea M Rehman Journal: EClinicalMedicine Date: 2021-11-13