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




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BMC Infectious Diseases

, 14:567

HIV and co-infections

Abstract

BackgroundIn 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.

MethodsThis 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.

Results161 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.

ConclusionsAfter 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.

KeywordsPediatric HIV HIV resistance Thymidine analogue mutations ART adherence HIV RNA Durability of antiretroviral therapy Viral load AbbreviationsARTAntiretroviral therapy

PMTCTPrevention of mother-to-child transmission

AZTZidovudine

d4TStavudine

3TCLamivudine

NNRTINon-nucleoside reverse transcriptase inhibitor

NVPNevirapine

EFVEfavirenz

LPV-rLopinovir and boosted ritonavir

ddIDidanosine

ABCAbacavir

WHOWorld Health Organization

CTCCare and treatment center

KCRIKilimanjaro Christian Research Institute

TAMsThymidine analog mutations

Electronic supplementary materialThe online version of this article doi:10.1186-s12879-014-0567-3 contains supplementary material, which is available to authorized users.

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Autor: Dorothy E Dow - Aisa M Shayo - Coleen K Cunningham - Elizabeth A Reddy

Fuente: https://link.springer.com/







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