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

Dow, D. E., Shayo, A. M., Cunningham, C. K. and Reddy, E. A. (2014) Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up. BMC Infectious Diseases, 14 (1). ISSN 1471-2334

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Abstract

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.

Item Type: Article
Keywords: Pediatric HIV, HIV resistance, Thymidine analogue mutations, ART adherence, HIV RNA, Durability of antiretroviral therapy, Viral load
Subjects: HIV > PMTCT (prevention of mother-to-child transmission)
Divisions: Kilimanjaro Christian Medical Centre
Depositing User: Digital Library Manager
Date Deposited: 02 Jun 2015 10:03
Last Modified: 02 Jun 2015 10:03
URI: http://ihi.eprints.org/id/eprint/3230

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