Caspian Chouraya1, Kim Ashburn2, Philisiwe Khumalo1, Lydia Mpango1, Nobuhle Mthethwa3, Rhoderick Machekano2, Laura Guay2,4, Lynne M Mofenson2. 1. From the Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini. 2. Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC. 3. Eswatini Ministry of Health, Mbabane, Eswatini. 4. Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC.
Abstract
BACKGROUND: Global pediatric treatment goals are for 90% of known children living with HIV to be on antiretroviral therapy (ART), with 90% having viral suppression. We used enrollment data from a study evaluating a family-centered HIV care program in Eswatini to describe the ART histories and virologic outcomes of enrolled children living with HIV and identify factors associated with viral suppression (<1000 RNA copies/mL) and undetectability (<400 RNA copies/mL). METHODS: Factors associated with viral suppression and undetectability were identified using Pearson χ for categorical variables and Wilcoxon rank sum tests for continuous variables. RESULTS: Three hundred seventy-seven children were enrolled, median age 8.5 years. Median age at HIV diagnosis was 2.1 years; at ART initiation, 2.6 years; and ART duration at enrollment, 4.1 years. Ninety-nine percent were receiving ART; 95.2% were on first-line ART and 4.8% on second-line ART. Most children (43.1%) were receiving nevirapine-based ART (median age 9.2 years), with 31.3% on lopinavir-ritonavir-based (median age 5.4 years) and 25.5%, efavirenz-based ART (median age 10.3 years). Viral suppression (<1000 copies/mL) was observed in 77.9% and undetectability (<400 copies/mL) in 73.5% of children. The only factor significantly associated with viral suppression was ART regimen, with 72.1% of children on nevirapine-based ART versus 86.7% on efavirenz-based ART virally suppressed. CONCLUSIONS: Although 99% of children enrolled in the study were receiving ART, viral suppression was observed in only 77.9%, with lowest rates among children receiving nevirapine-based ART. These findings highlight the critical importance of monitoring treatment regimen for optimizing treatment outcomes for pediatric HIV.
BACKGROUND: Global pediatric treatment goals are for 90% of known children living with HIV to be on antiretroviral therapy (ART), with 90% having viral suppression. We used enrollment data from a study evaluating a family-centered HIV care program in Eswatini to describe the ART histories and virologic outcomes of enrolled children living with HIV and identify factors associated with viral suppression (<1000 RNA copies/mL) and undetectability (<400 RNA copies/mL). METHODS: Factors associated with viral suppression and undetectability were identified using Pearson χ for categorical variables and Wilcoxon rank sum tests for continuous variables. RESULTS: Three hundred seventy-seven children were enrolled, median age 8.5 years. Median age at HIV diagnosis was 2.1 years; at ART initiation, 2.6 years; and ART duration at enrollment, 4.1 years. Ninety-nine percent were receiving ART; 95.2% were on first-line ART and 4.8% on second-line ART. Most children (43.1%) were receiving nevirapine-based ART (median age 9.2 years), with 31.3% on lopinavir-ritonavir-based (median age 5.4 years) and 25.5%, efavirenz-based ART (median age 10.3 years). Viral suppression (<1000 copies/mL) was observed in 77.9% and undetectability (<400 copies/mL) in 73.5% of children. The only factor significantly associated with viral suppression was ART regimen, with 72.1% of children on nevirapine-based ART versus 86.7% on efavirenz-based ART virally suppressed. CONCLUSIONS: Although 99% of children enrolled in the study were receiving ART, viral suppression was observed in only 77.9%, with lowest rates among children receiving nevirapine-based ART. These findings highlight the critical importance of monitoring treatment regimen for optimizing treatment outcomes for pediatric HIV.
Authors: Isaac Tsikhutsu; Margaret Bii; Nicole Dear; Kavitha Ganesan; Alex Kasembeli; Valentine Sing'oei; Kevin Rombosia; Christopher Ochieng; Priyanka Desai; Vanessa Wolfman; Peter Coakley; Elizabeth H Lee; Patrick W Hickey; Jeffrey Livezey; Patricia Agaba Journal: Clin Infect Dis Date: 2022-09-29 Impact factor: 20.999
Authors: Joel Maena; Aduragbemi Banke-Thomas; Nelson Mukiza; Cynthia Ndikuno Kuteesa; Ronald Makanga Kakumba; Hajira Kataike; Samuel Kizito; Juliet Allen Babirye; Rita Nakalega Journal: AIDS Res Ther Date: 2021-12-04 Impact factor: 2.250