Irene Marete1, Ann Mwangi2, Steven Brown3, Kara Wools-Kaloustian4, Constantin Yiannoutsos5, Lisa Abuogi6, Rita Lyamuya7, Kapella Ngonyani8, Marion Achieng9, Cosmas Apaka10, Elyne Rotich10, Samuel Ayaya1. 1. Department of Pediatrics and Child Health, Moi University School of Medicine, P.O. Box 4606-30100 Kenya. 2. Department of Behavioral Sciences, Moi University School of Medicine, P.O. Box 4606-30100 Kenya. 3. Department of Biostatistics, Indiana University School of Medicine, 410 W. 10th Street, Suite 3000 Indianapolis, IN 46202- 3002. 4. Department of Medicine, Indiana University School of Medicine, Rotary Building Room 132B 702 Rotary Circle Indianapolis, IN, USA 46202. 5. R.M. Fairbanks School of Public Health, Department of Biostatistics, Indiana University School of Medicine,410 W. 10th Street, Suite 3000 Indianapolis, IN 46202- 3002. 6. University of Colorado, Denver, Colorado. 13199 East Montview Blvd, Suite 310 Mail Stop A090, Aurora, CO, USA 80045. 7. Morogoro Regional Referral Hospital, P.O.BOX 110, Morogoro, Tanzania. 8. Tumbi Regional Referral Hospital P. O. Box 30041, Kibaha, Pwani, Tanzania. 9. Infectious Diseases Institute, College of Health Sciences, Makerere University, 3 rd Floor, West Wing, IDI Knowledge Centre, Makerere University Main Campus, P.O Box 22418, Kampala Uganda. 10. Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100 Kenya.
Abstract
Objectives: To describe the incidence of antiretroviral treatment failure and associated factors in a pediatric clinical cohort within the East African International epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium. Design: A retrospective cohort study. Clinical treatment failure was defined as advancement in clinical WHO stage, or CDC class at least 24 weeks after initiation of treatment. Immunological failure was defined as developing or returning to the following age-related immunological thresholds after at least 24 weeks on treatment; CD4 count of <200 or CD4%<10% for children aged 2-5 years and CD4 count of < 100 for a child aged > 5years. Setting: The study utilized the electronic medical records of HIV-infected pediatric patients enrolled into the EA-IeDEA consortium clinics from January 2005 to August 2012. Results: A total of 5927 children were included in the analysis. The estimated cumulative incidence of clinical ART treatment failure at one year and four years post ART initiation was11.5% and 31% respectively, while that of immunological treatment failure was at 3% and 22.5% respectively. The main factors associated with clinical failure were advanced clinical stage at ART-initiation, year started ART and residing in a rural area. Factors associated with immunological failure were male gender and age of the child at ART-initiation. Only 6% of those identified as having clinical treatment failure were switched to second line treatment during the four years of follow-up. Conclusion: The probability of clinical and immunologic failure was relatively high and increased with time.
Objectives: To describe the incidence of antiretroviral treatment failure and associated factors in a pediatric clinical cohort within the East African International epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium. Design: A retrospective cohort study. Clinical treatment failure was defined as advancement in clinical WHO stage, or CDC class at least 24 weeks after initiation of treatment. Immunological failure was defined as developing or returning to the following age-related immunological thresholds after at least 24 weeks on treatment; CD4 count of <200 or CD4%<10% for children aged 2-5 years and CD4 count of < 100 for a child aged > 5years. Setting: The study utilized the electronic medical records of HIV-infected pediatric patients enrolled into the EA-IeDEA consortium clinics from January 2005 to August 2012. Results: A total of 5927 children were included in the analysis. The estimated cumulative incidence of clinical ART treatment failure at one year and four years post ART initiation was11.5% and 31% respectively, while that of immunological treatment failure was at 3% and 22.5% respectively. The main factors associated with clinical failure were advanced clinical stage at ART-initiation, year started ART and residing in a rural area. Factors associated with immunological failure were male gender and age of the child at ART-initiation. Only 6% of those identified as having clinical treatment failure were switched to second line treatment during the four years of follow-up. Conclusion: The probability of clinical and immunologic failure was relatively high and increased with time.
Authors: Anand Reddi; Sarah C Leeper; Anneke C Grobler; Rosemary Geddes; K Holly France; Gillian L Dorse; Willem J Vlok; Mbali Mntambo; Monty Thomas; Kristy Nixon; Helga L Holst; Quarraisha Abdool Karim; Nigel C Rollins; Hoosen M Coovadia; Janet Giddy Journal: BMC Pediatr Date: 2007-03-17 Impact factor: 2.125