Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana

BMC Infectious Diseases

Elijah Paintsil³  Veronika Shabanova¹  Kwamena WC Sagoe⁶  Bamenla Goka⁶  Jonas Kusah⁶  William Ampofo⁵  Meghan Prin²  Evelyn Y Bonney⁵  Lorna Renner⁶  Jonathan Powell⁴  Oliver Barry² 

[1] Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, CT, USA;From the Columbia University, New York, NY, USA;Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, CT, USA;Weill Cornell Medical College, New York, NY, USA;Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana;University of Ghana Medical School, Accra, Ghana

关键词: HIV drug resistance mutations;    Virologic failure;    Laboratory monitoring;    Antiretroviral therapy;    Pediatrics;   

Others  :  1145697
DOI  :  10.1186/1471-2334-13-476

 received in 2013-06-18, accepted in 2013-10-07,  发布年份 2013

【 摘 要 】

Background

Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load.

Methods

We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis.

Results

Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with ≥ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child’s gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes.

Conclusions

First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries.

【 授权许可】

   
2013 Barry et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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