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

Dow, Dorothy E

Shayo, Aisa M

Cunningham, Coleen K

Reddy, Elizabeth A

England

2015-06-04T20:44:54Z

2014-11-07

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.

http://www.ncbi.nlm.nih.gov/pubmed/25373425

s12879-014-0567-3

1471-2334

https://hdl.handle.net/10161/10203

eng

Springer Science and Business Media LLC

BMC Infect Dis

10.1186/s12879-014-0567-3

Adolescent

Anti-HIV Agents

Child

Cross-Sectional Studies

Drug Resistance, Viral

Female

Follow-Up Studies

HIV Infections

HIV-1

Humans

Infectious Disease Transmission, Vertical

Male

Prospective Studies

RNA, Viral

Retrospective Studies

Tanzania

Treatment Failure

Viral Load

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

Journal article

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

http://www.ncbi.nlm.nih.gov/pubmed/25373425

567

Clinical Science Departments

Duke

Global Health Institute

Institutes and Provost's Academic Units

Pathology

Pediatrics

Pediatrics, Infectious Diseases

School of Medicine

University Institutes and Centers

Published online

14