Predictors of Virologic Failure Among a Cohort of HIV-infected Children in Southern Ethiopia
(2021) In Pediatric Infectious Disease Journal 40(1). p.60-65- Abstract
BACKGROUND: Optimal care for children with HIV infection includes timely assessment of treatment failure. Using HIV viral load to define treatment failure remains a challenge in resource-limited settings.
METHODS: Children with HIV infection who were already on or starting first-line antiretroviral therapy were enrolled and followed over time. We examined clinical and immunologic predictors of virologic failure (VF), defined as consecutive viral load measurements > 1000 copies/mL (VF). Children were followed every 6 months with clinical assessments, immunologic assays and viral load testing until treatment failure or up to 18 months.
RESULTS: Of the 484 children with complete data, we observed a prevalence of 15% who had... (More)
BACKGROUND: Optimal care for children with HIV infection includes timely assessment of treatment failure. Using HIV viral load to define treatment failure remains a challenge in resource-limited settings.
METHODS: Children with HIV infection who were already on or starting first-line antiretroviral therapy were enrolled and followed over time. We examined clinical and immunologic predictors of virologic failure (VF), defined as consecutive viral load measurements > 1000 copies/mL (VF). Children were followed every 6 months with clinical assessments, immunologic assays and viral load testing until treatment failure or up to 18 months.
RESULTS: Of the 484 children with complete data, we observed a prevalence of 15% who had VF at enrollment, and 18 who developed VF over 10.5 person-years of follow-up for an incidence of 4.97 [95% CI: 3.04-7.70) per 100 person-years. Lower adherence, lower CD4 T-cell count, lower white blood cells count, lower platelets and a lower glomerular filtration rate were all associated with increased VF. However, in a multivariable analysis, renal function (estimated glomerular filtration rate < 90 mL/min), odds ratio: 11.5 (95% CI: 1.5-63.7), and lower adherence, odds ratio: 3.9 (95% CI: 1.1-13.4), were the only factors associated with development of VF.
CONCLUSIONS: We identified a significant risk of VF in children with HIV infection in a prospective cohort study in southern Ethiopia and limited predictive value of clinical variables for VF. This provides further evidence that rapid and reliable viral load testing is needed to adequately address the HIV epidemic, along with implementation of adherence interventions in sub-Saharan Africa.
(Less)
- author
- Tadesse, Birkneh Tilahun ; Foster, Byron Alexander ; Latour, Emile ; Lim, Jeong Youn ; Jerene, Degu LU ; Ruff, Andrea and Aklillu, Eleni
- publishing date
- 2021-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adolescent, Anti-Retroviral Agents/therapeutic use, Antiretroviral Therapy, Highly Active, Child, Ethiopia, Female, HIV Infections/drug therapy, Humans, Male, Prospective Studies, Treatment Failure, Viral Load/statistics & numerical data
- in
- Pediatric Infectious Disease Journal
- volume
- 40
- issue
- 1
- pages
- 60 - 65
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:85097574306
- pmid:32925538
- ISSN
- 1532-0987
- DOI
- 10.1097/INF.0000000000002898
- language
- English
- LU publication?
- no
- id
- 76841f79-9162-42bd-9638-9b1b1ac353e6
- date added to LUP
- 2021-09-08 17:47:15
- date last changed
- 2024-04-06 08:29:22
@article{76841f79-9162-42bd-9638-9b1b1ac353e6,
abstract = {{<p>BACKGROUND: Optimal care for children with HIV infection includes timely assessment of treatment failure. Using HIV viral load to define treatment failure remains a challenge in resource-limited settings.</p><p>METHODS: Children with HIV infection who were already on or starting first-line antiretroviral therapy were enrolled and followed over time. We examined clinical and immunologic predictors of virologic failure (VF), defined as consecutive viral load measurements > 1000 copies/mL (VF). Children were followed every 6 months with clinical assessments, immunologic assays and viral load testing until treatment failure or up to 18 months.</p><p>RESULTS: Of the 484 children with complete data, we observed a prevalence of 15% who had VF at enrollment, and 18 who developed VF over 10.5 person-years of follow-up for an incidence of 4.97 [95% CI: 3.04-7.70) per 100 person-years. Lower adherence, lower CD4 T-cell count, lower white blood cells count, lower platelets and a lower glomerular filtration rate were all associated with increased VF. However, in a multivariable analysis, renal function (estimated glomerular filtration rate < 90 mL/min), odds ratio: 11.5 (95% CI: 1.5-63.7), and lower adherence, odds ratio: 3.9 (95% CI: 1.1-13.4), were the only factors associated with development of VF.</p><p>CONCLUSIONS: We identified a significant risk of VF in children with HIV infection in a prospective cohort study in southern Ethiopia and limited predictive value of clinical variables for VF. This provides further evidence that rapid and reliable viral load testing is needed to adequately address the HIV epidemic, along with implementation of adherence interventions in sub-Saharan Africa.</p>}},
author = {{Tadesse, Birkneh Tilahun and Foster, Byron Alexander and Latour, Emile and Lim, Jeong Youn and Jerene, Degu and Ruff, Andrea and Aklillu, Eleni}},
issn = {{1532-0987}},
keywords = {{Adolescent; Anti-Retroviral Agents/therapeutic use; Antiretroviral Therapy, Highly Active; Child; Ethiopia; Female; HIV Infections/drug therapy; Humans; Male; Prospective Studies; Treatment Failure; Viral Load/statistics & numerical data}},
language = {{eng}},
number = {{1}},
pages = {{60--65}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Pediatric Infectious Disease Journal}},
title = {{Predictors of Virologic Failure Among a Cohort of HIV-infected Children in Southern Ethiopia}},
url = {{http://dx.doi.org/10.1097/INF.0000000000002898}},
doi = {{10.1097/INF.0000000000002898}},
volume = {{40}},
year = {{2021}},
}