Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up.

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2014-11-07

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Abstract

BACKGROUND: In Tanzania, HIV-1 RNA testing is rarely available and not standard of care. Determining virologic failure is challenging and resistance mutations accumulate, thereby compromising second-line therapy. We evaluated durability of antiretroviral therapy (ART) and predictors of virologic failure among a pediatric cohort at four-year follow-up. METHODS: This was a prospective cross-sectional study with retrospective chart review evaluating a perinatally HIV-infected Tanzanian cohort enrolled in 2008-09 with repeat HIV-1 RNA in 2012-13. Demographic, clinical, and laboratory data were extracted from charts, resistance mutations from 2008-9 were analyzed, and prospective HIV RNA was obtained. RESULTS: 161 (78%) participants of the original cohort consented to repeat HIV RNA. The average age was 12.2 years (55% adolescents ≥12 years). Average time on ART was 6.4 years with 41% receiving second-line (protease inhibitor based) therapy. Among those originally suppressed on a first-line (non-nucleoside reverse transcriptase based regimen) 76% remained suppressed. Of those originally failing first-line, 88% were switched to second-line and 72% have suppressed virus. Increased level of viremia and duration of ART trended with an increased number of thymidine analogue mutations (TAMs). Increased TAMs increased the odds of virologic failure (p = 0.18), as did adolescent age (p < 0.01). CONCLUSIONS: After viral load testing in 2008-09 many participants switched to second-line therapy. The majority achieved virologic suppression despite multiple resistance mutations. Though virologic testing would likely hasten the switch to second-line among those failing, methods to improve adherence is critical to maximize durability of ART and improve virologic outcomes among youth in resource-limited settings.

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10.1186/s12879-014-0567-3

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Dow, Dorothy E, Aisa M Shayo, Coleen K Cunningham and Elizabeth A Reddy (2014). Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up. BMC Infect Dis, 14. p. 567. 10.1186/s12879-014-0567-3 Retrieved from https://hdl.handle.net/10161/10203.

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Dow

Dorothy Elizabeth Dow

Associate Professor of Pediatrics

Dorothy Dow, MD, MSc is Assistant Professor of Pediatrics and Assistant Research Professor at the Duke Global Health Institute.  Dr. Dow’s research focuses on prevention and treatment of HIV in pediatric populations including prevention of mother-to-child transmission and a focus on adolescent and young adult populations.  Dr. Dow is co-chair of IMPAACT Network Protocol 2016 and a member of the AHISA network.  She is co-site leader of the Kilimanjaro Christian Medical Centre-Duke University Collaboration where she works nearly full time in Moshi, Tanzania, though returns to Duke University Medical Center two-weeks twice per year to attend on the clinical inpatient consult service. 

 


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