Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.
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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.
CD4 Lymphocyte Count
Predictive Value of Tests
Severity of Illness Index
Published Version (Please cite this version)10.1097/QAI.0b013e3181cf4882
Publication InfoBartlett, 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 http://hdl.handle.net/10161/14574.
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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
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.
Assistant Professor - Track IV 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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