Patience Nyakato1, Michael Schomaker1,2, Nosisa Sipambo3, Karl-Günter Technau4, Geoffrey Fatti5,6, Helena Rabie7, Frank Tanser8, Brian Eley9, Jonathan Euvrard1,10, Robin Wood11, Priscilla R Tsondai1, Constantin T Yiannoutsos12, Morna Cornell1, Mary-Ann Davies1. 1. Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 2. Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria. 3. Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Department of Paediatrics & Child Health, University of Witwatersrand, Johannesburg. 4. Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand. 5. Kheth'Impilo AIDS-Free Living, Cape Town. 6. Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town. 7. Department of Paediatrics and Child Health, Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch. 8. Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele. 9. Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town. 10. Khayelitsha ART Programme and Médecins Sans Frontières, Khayelitsha, Cape Town. 11. Gugulethu HIV Programme and Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa. 12. R.M. Fairbanks School of Public Health, Department of Biostatistics, Indiana University, Indianapolis, USA.
Abstract
BACKGROUND AND OBJECTIVES: Adolescents living with perinatally acquired HIV (ALPHIV) on antiretroviral therapy (ART) have been noted to have poorer adherence, retention and virologic control compared to adolescents with non-perinatally acquired HIV, children or adults. We aimed to describe and examine factors associated with longitudinal virologic response during early adolescence. DESIGN: A retrospective cohort study. METHODS: We included ALPHIV who initiated ART before age 9.5 years in South African cohorts of the International epidemiology Database to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration (2004-2016); with viral load (VL) values <400 copies/ml at age 10 years and at least one VL measurement after age 10 years. We used a log-linear quantile mixed model to assess factors associated with elevated (75th quantile) VLs. RESULTS: We included 4396 ALPHIV, 50.7% were male, with median (interquartile range) age at ART start of 6.5 (4.5, 8.1) years. Of these, 74.9% were on a non-nucleoside reverse transcriptase inhibitor (NNRTI) at age 10 years. After adjusting for other patient characteristics, the 75th quantile VLs increased with increasing age being 3.13-fold (95% CI 2.66, 3.68) higher at age 14 versus age 10, were 3.25-fold (95% CI 2.81, 3.75) higher for patients on second-line protease-inhibitor and 1.81-fold for second-line NNRTI-based regimens (versus first-line NNRTI-based regimens). There was no difference by sex. CONCLUSIONS: As adolescents age between 10 and 14 years, they are increasingly likely to experience higher VL values, particularly if receiving second-line protease inhibitor or NNRTI-based regimens, which warrant adherence support interventions.
BACKGROUND AND OBJECTIVES: Adolescents living with perinatally acquired HIV (ALPHIV) on antiretroviral therapy (ART) have been noted to have poorer adherence, retention and virologic control compared to adolescents with non-perinatally acquired HIV, children or adults. We aimed to describe and examine factors associated with longitudinal virologic response during early adolescence. DESIGN: A retrospective cohort study. METHODS: We included ALPHIV who initiated ART before age 9.5 years in South African cohorts of the International epidemiology Database to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration (2004-2016); with viral load (VL) values <400 copies/ml at age 10 years and at least one VL measurement after age 10 years. We used a log-linear quantile mixed model to assess factors associated with elevated (75th quantile) VLs. RESULTS: We included 4396 ALPHIV, 50.7% were male, with median (interquartile range) age at ART start of 6.5 (4.5, 8.1) years. Of these, 74.9% were on a non-nucleoside reverse transcriptase inhibitor (NNRTI) at age 10 years. After adjusting for other patient characteristics, the 75th quantile VLs increased with increasing age being 3.13-fold (95% CI 2.66, 3.68) higher at age 14 versus age 10, were 3.25-fold (95% CI 2.81, 3.75) higher for patients on second-line protease-inhibitor and 1.81-fold for second-line NNRTI-based regimens (versus first-line NNRTI-based regimens). There was no difference by sex. CONCLUSIONS: As adolescents age between 10 and 14 years, they are increasingly likely to experience higher VL values, particularly if receiving second-line protease inhibitor or NNRTI-based regimens, which warrant adherence support interventions.
Authors: Matthias Egger; Didier K Ekouevi; Carolyn Williams; Rita Elias Lyamuya; Henri Mukumbi; Paula Braitstein; Tyler Hartwell; Claire Graber; Benjamin H Chi; Andrew Boulle; François Dabis; Kara Wools-Kaloustian Journal: Int J Epidemiol Date: 2011-05-18 Impact factor: 7.196
Authors: Habib O Ramadhani; John A Bartlett; Nathan M Thielman; Brian W Pence; Stephen M Kimani; Venance P Maro; Mtumwa S Mwako; Lazaro J Masaki; Calvin E Mmbando; Mary G Minja; Eileen S Lirhunde; William C Miller Journal: Open Forum Infect Dis Date: 2014-09-09 Impact factor: 3.835
Authors: Ragna S Boerma; Torsak Bunupuradah; Dorothy Dow; Joseph Fokam; Azar Kariminia; Dara Lehman; Cissy Kityo; Victor Musiime; Paul Palumbo; Annelot Schoffelen; Sam Sophan; Brian Zanoni; Tobias F Rinke de Wit; Job C J Calis; Kim C E Sigaloff Journal: J Int AIDS Soc Date: 2017-09-15 Impact factor: 5.396
Authors: Annouschka M Weijsenfeld; Charlotte Blokhuis; Martijn M Stuiver; Ferdinand W N M Wit; Dasja Pajkrt Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817