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.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.identifier | ||
| dc.identifier.eissn | 1944-7884 | |
| dc.identifier.uri | ||
| 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.orcid | Emmett, Susan D|0000-0003-4257-8161 | |
| duke.contributor.orcid | Cunningham, Coleen K|0000-0002-7725-3052 | |
| duke.contributor.orcid | Mmbaga, Blandina T|0000-0002-5550-1916 | |
| duke.contributor.orcid | Crump, John A|0000-0002-4529-102X | |
| pubs.author-url | ||
| 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 |