Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.
Abstract
BACKGROUND: Many HIV care and treatment programs in resource-limited settings rely
on clinical and immunologic monitoring of antiretroviral therapy (ART), but accuracy
of this strategy to detect virologic failure (VF) among children has not been evaluated.
METHODS: A cross-sectional sample of HIV-infected children aged 1-16 years on ART
>or=6 months receiving care at a Tanzanian referral center underwent clinical staging,
CD4 lymphocyte measurement, plasma HIV-1 RNA level, and complete blood count. Associations
with VF (HIV-1 RNA >or=400 copies/mL) were determined utilizing bivariable and multivariate
analyses; accuracy of current clinical and immunologic guidelines in identifying children
with VF was assessed. FINDINGS: Of 206 children (median age 8.7 years, ART duration
2.4 years), 65 (31.6%) demonstrated VF at enrollment. Clinical and immunological criteria
identified 2 (3.5%) of 57 children with VF on first-line therapy, exhibiting 3.5%
sensitivity and 100% specificity. VF was associated with younger age, receipt of nevirapine
vs. efavirenz-based regimen, CD4% < 25%, and physician documentation of maladherence
(P < 0.05 on bivariable analysis); the latter 2 factors remained significant on multivariate
logistic regression. INTERPRETATION: This study demonstrates poor performance of clinical
and immunologic criteria in identifying children with virologic failure. Affordable
techniques for measuring HIV-1 RNA level applicable in resource-limited settings are
urgently needed.
Type
Journal articleSubject
AdolescentAnti-HIV Agents
Anti-Retroviral Agents
Antigens, CD4
Benzoxazines
CD4 Lymphocyte Count
Child
Child, Preschool
Cross-Sectional Studies
Female
Follow-Up Studies
HIV Infections
HIV-1
Humans
Infant
Male
Nevirapine
Predictive Value of Tests
RNA, Viral
Recurrence
Severity of Illness Index
Tanzania
Treatment Failure
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https://hdl.handle.net/10161/14574Published Version (Please cite this version)
10.1097/QAI.0b013e3181cf4882Publication Info
Bartlett, John A; Crump, John Andrew; Cunningham, Coleen; Emmett, Susan D; Kinabo,
GD; Mmbaga, BT; ... Swai, ME (2010). Predicting virologic failure among HIV-1-infected children receiving antiretroviral
therapy in Tanzania: a cross-sectional study. J Acquir Immune Defic Syndr, 54(4). pp. 368-375. 10.1097/QAI.0b013e3181cf4882. Retrieved from https://hdl.handle.net/10161/14574.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’s
collaborative research program based at Kilimanjaro Christian Medical Centre and Director
of Tanzania Operations for the Duke Global Health Institute. I oversee the design
and implementation of research studies on infectious diseases, particularly febrile
illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical
trials of antiretroviral therapy and prevention of mother-to-child tr
Coleen Kathryn Cunningham
Professor of Pediatrics
Dr. Cunningham is a pediatric infectious diseases physician who has focused her research
on the prevention and treatment of HIV infection in children. She has also played
important roles in evaluation of vaccines for other infectious diseases and recently
has worked on Ebola virus treatment studies. She is currently working on studies
of active and passive immunization to prevent HIV transmission in neonates born to
HIV infected women.
Susan D Emmett
Assistant Professor of Surgery
My research focuses on reducing hearing health disparities globally. I work with colleagues
around the world to define the global burden of hearing loss and deepen our understanding
of its social, economic, and health impact. We apply a public health approach that
spans prevention, diagnosis, and treatment.
Fundamental to prevention is evaluating why hearing loss is so much more common in
low-resource settings and investigating risk factors that are potentially modifiable.
I have focu
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