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Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.

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Date
2010-08
Authors
Emmett, Susan D
Cunningham, Coleen K
Mmbaga, Blandina T
Kinabo, Grace D
Schimana, Werner
Swai, Mark E
Bartlett, John A
Crump, John A
Reddy, Elizabeth A
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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 article
Subject
Adolescent
Anti-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
Permalink
https://hdl.handle.net/10161/14574
Published Version (Please cite this version)
10.1097/QAI.0b013e3181cf4882
Publication Info
Emmett, Susan D; Cunningham, Coleen K; Mmbaga, Blandina T; Kinabo, Grace D; Schimana, Werner; Swai, Mark E; ... Reddy, Elizabeth A (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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Scholars@Duke

Bartlett

John Alexander Bartlett

Professor of Medicine
My clinical investigation is focused on the pathogenesis and treatment of HIV infection and its complicastions, especially in resource-limited settings. Key Words: HIV infection, AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
Cunningham

Coleen Kathryn Cunningham

Adjunct Professor in the Department 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.
Emmett

Susan D Emmett

Associate Professor of Head and Neck Surgery & Communication Sciences
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
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Alphabetical list of authors with Scholars@Duke profiles.
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