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

dc.contributor.author Emmett, Susan D
dc.contributor.author Cunningham, Coleen K
dc.contributor.author Mmbaga, Blandina T
dc.contributor.author Kinabo, Grace D
dc.contributor.author Schimana, Werner
dc.contributor.author Swai, Mark E
dc.contributor.author Bartlett, John A
dc.contributor.author Crump, John A
dc.contributor.author Reddy, Elizabeth A
dc.coverage.spatial United States
dc.date.accessioned 2017-05-18T15:36:56Z
dc.date.available 2017-05-18T15:36:56Z
dc.date.issued 2010-08
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/20216225
dc.identifier.uri https://hdl.handle.net/10161/14574
dc.description.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.
dc.language eng
dc.publisher Ovid Technologies (Wolters Kluwer Health)
dc.relation.ispartof J Acquir Immune Defic Syndr
dc.relation.isversionof 10.1097/QAI.0b013e3181cf4882
dc.subject Adolescent
dc.subject Anti-HIV Agents
dc.subject Anti-Retroviral Agents
dc.subject Antigens, CD4
dc.subject Benzoxazines
dc.subject CD4 Lymphocyte Count
dc.subject Child
dc.subject Child, Preschool
dc.subject Cross-Sectional Studies
dc.subject Female
dc.subject Follow-Up Studies
dc.subject HIV Infections
dc.subject HIV-1
dc.subject Humans
dc.subject Infant
dc.subject Male
dc.subject Nevirapine
dc.subject Predictive Value of Tests
dc.subject RNA, Viral
dc.subject Recurrence
dc.subject Severity of Illness Index
dc.subject Tanzania
dc.subject Treatment Failure
dc.title Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.
dc.type Journal article
duke.contributor.id Emmett, Susan D|0407433
duke.contributor.id Cunningham, Coleen K|0308797
duke.contributor.id Bartlett, John A|0058484
duke.contributor.id Reddy, Elizabeth A|0399368
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/20216225
pubs.begin-page 368
pubs.end-page 375
pubs.issue 4
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Duke Science & Society
pubs.organisational-group Initiatives
pubs.organisational-group Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Nursing
pubs.organisational-group Pathology
pubs.organisational-group Pediatrics
pubs.organisational-group Pediatrics, Infectious Diseases
pubs.organisational-group School of Medicine
pubs.organisational-group School of Nursing
pubs.publication-status Published
pubs.volume 54
dc.identifier.eissn 1944-7884
duke.contributor.orcid Emmett, Susan D|0000-0003-4257-8161
duke.contributor.orcid Cunningham, Coleen K|0000-0002-7725-3052


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