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

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Emmett, Susan D

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Cunningham, Coleen K

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Mmbaga, Blandina T

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Kinabo, Grace D

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Schimana, Werner

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Swai, Mark E

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Bartlett, John A

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Crump, John A

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Reddy, Elizabeth A

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United States

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2017-05-18T15:36:56Z

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2017-05-18T15:36:56Z

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2010-08

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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.

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https://www.ncbi.nlm.nih.gov/pubmed/20216225

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1944-7884

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https://hdl.handle.net/10161/14574

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eng

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Ovid Technologies (Wolters Kluwer Health)

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J Acquir Immune Defic Syndr

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10.1097/QAI.0b013e3181cf4882

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Adolescent

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Anti-HIV Agents

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Anti-Retroviral Agents

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Antigens, CD4

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Benzoxazines

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CD4 Lymphocyte Count

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Child

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Child, Preschool

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Cross-Sectional Studies

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Female

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Follow-Up Studies

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HIV Infections

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HIV-1

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Humans

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Infant

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Male

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Nevirapine

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Predictive Value of Tests

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RNA, Viral

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Recurrence

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Severity of Illness Index

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Tanzania

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Treatment Failure

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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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Journal article

duke.contributor.orcid

Emmett, Susan D|0000-0003-4257-8161

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Cunningham, Coleen K|0000-0002-7725-3052

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Mmbaga, Blandina T|0000-0002-5550-1916

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https://www.ncbi.nlm.nih.gov/pubmed/20216225

pubs.begin-page

368

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375

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4

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Clinical Science Departments

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Duke

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Duke Cancer Institute

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Duke Science & Society

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Initiatives

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Institutes and Centers

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Institutes and Provost's Academic Units

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Medicine

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Medicine, Infectious Diseases

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Nursing

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Pathology

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Pediatrics

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Pediatrics, Infectious Diseases

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School of Medicine

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School of Nursing

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Published

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54

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