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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Immunovirological response to combined antiretroviral therapy and drug resistance patterns in children: 1- and 2-year outcomes in rural Uganda
BMC Pediatrics, Volume 11, Article 67, Year 2011
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Description
Background: Children living with HIV continue to be in urgent need of combined antiretroviral therapy (ART). Strategies to scale up and improve pediatric HIV care in resource-poor regions, especially in sub-Saharan Africa, require further research from these settings. We describe treatment outcomes in children treated in rural Uganda after 1 and 2 years of ART start.Methods: Cross-sectional assessment of all children treated with ART for 12 (M12) and 24 (M24) months was performed. CD4 counts, HIV RNA levels, antiretroviral resistance patterns, and non-nucleoside reverse transcriptase inhibitor (NNRTI) plasma concentrations were determined. Patient adherence and antiretroviral-related toxicity were assessed.Results: Cohort probabilities of retention in care were 0.86 at both M12 and M24. At survey, 71 (83%, M12) and 32 (78%, M24) children remained on therapy, and 84% participated in the survey. At ART start, 39 (45%) were female; median age was 5 years. Median initial CD4 percent was 11% [IQR 9-15] in children < 5 years old (n = 12); CD4 count was 151 cells/mm3 [IQR 38-188] in those ≥ 5 years old (n = 26). At M12, median CD4 gains were 11% [IQR 10-14] in patients < 5 years old, and 206 cells/mm3 [IQR 98-348] in ≥ 5 years old. At M24, median CD4 gains were 11% [IQR 5-17] and 132 cells/mm3 [IQR 87-443], respectively. Viral suppression (< 400 copies/mL) was achieved in 59% (M12) and 33% (M24) of children. Antiretroviral resistance was found in 25% (M12) and 62% (M24) of children. Overall, 29% of patients had subtherapeutic NNRTI plasma concentrations.Conclusions: After one year of therapy, satisfactory survival and immunological responses were observed, but nearly 1 in 4 children developed viral resistance and/or subtherapeutic plasma antiretroviral drug levels. Regular weight-adjustment dosing and strategies to reinforce and maintain ART adherence are essential to maximize duration of first-line therapy in children in resource-limited countries. © 2011 Ahoua et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Ahoua, Laurence Natacha
France, Paris
Clinical Research Department
Günther, Gunar
France, Paris
Clinical Research Department
Rouzioux, Christine
France, Paris
Hôpital Necker Enfants Malades
Pinoges, Loretxu L.P.
France, Paris
Clinical Research Department
Anguzu, Paul
Switzerland, Geneva
Medecins Sans Frontieres
Taburet, Anne Marie
France, Le Kremlin-bicetre
Hopital de Bicetre
Balkan, Suna
Switzerland, Geneva
Medecins Sans Frontieres
Olson, David M.
Switzerland, Geneva
Medecins Sans Frontieres
Olaro, Charles
Uganda
Arua Regional Referral Hospital
Pujades Rodríguez, María Del Mar
France, Paris
Clinical Research Department
Statistics
Citations: 19
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1186/1471-2431-11-67
e-ISSN:
14712431
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda
Participants Gender
Female