TY - JOUR
T1 - Predictors of Virologic Failure Among a Cohort of HIV-infected Children in Southern Ethiopia
AU - Tadesse, Birkneh Tilahun
AU - Foster, Byron Alexander
AU - Latour, Emile
AU - Lim, Jeong Youn
AU - Jerene, Degu
AU - Ruff, Andrea
AU - Aklillu, Eleni
N1 - Funding Information:
Accepted for publication August 25, 2020. From the *Department of Pediatrics, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; †School of Medicine and ‡ Biosta-tistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon; §KNCV Tuberculosis Foundation, The Hague, the Netherlands; ¶Department of International Health, Johns Hopkins Uni-versity Bloomberg School of Public Health, Baltimore, Maryland; and ║Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. This work supported by a grant from the International AIDS Society, Collabora-tive Initiative for Paediatric HIV Education and Research (TAD-307) and Swedish Research Council (Vetenskapsrådet) grant number: 2015-03295. The authors have no conflicts of interest to disclose. B.T.T. and B.A.F. are co-first authors Address for correspondence: Byron Alexander Foster, MD, MPH, 3181 SW Sam Jackson Park Rd, MC CDRC-P, Portland, OR 97239. E-mail: fosterb@ohsu.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com) Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0891-3668/21/4001-0060 DOI: 10.1097/INF.0000000000002898
Funding Information:
This work supported by a grant from the International AIDS Society, Collaborative Initiative for Paediatric HIV Education and Research (TAD-307) and Swedish Research Council (Vetenskapsrådet) grant number: 2015-03295.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - 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.
AB - 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.
KW - Ethiopia
KW - HIV
KW - children
KW - highly active antiretroviral therapy
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U2 - 10.1097/INF.0000000000002898
DO - 10.1097/INF.0000000000002898
M3 - Article
C2 - 32925538
AN - SCOPUS:85097574306
SN - 0891-3668
VL - 40
SP - 60
EP - 65
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 1
ER -