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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term outcome of children receiving antiretroviral treatment in rural South Africa: Substantial virologic failure on first-line treatment
Pediatric Infectious Disease Journal, Volume 30, No. 1, Year 2011
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Description
Background: Long-term (>12 months follow-up) virologic data of children receiving antiretroviral therapy (ART) in Sub-Saharan Africa are limited. Data from rural areas are especially scarce. The aim of this study was to evaluate the long-term virologic outcome of a pediatric cohort in rural South Africa. Methods: We performed a retrospective, observational cohort study, including children who initiated ART at least 1 year before data-analysis. Regular monitoring, including HIV-RNA testing, was performed. Genotypic resistance testing was done for children with virologic failure (HIV-RNA >1000 copies/mL). Logistic regression analysis was used to determine predictors of virologic failure. Results: A total of 101 children were included. Median duration since beginning ART was 31 months. Overall patient retention-rate was 76% (77/101), with early mortality being the main cause of attrition (13/24, 54%). Initial immunologic and virologic responses were excellent. However, 38% (31/81) of children subsequently experienced virologic failure. Correlation between virologic failure and immunologic decline was nearly absent. At the time of failure, multiple non-nucleoside reverse transcription inhibitor-associated mutations were observed in 52% (12/23) of children. No definite predictors of virologic failure could be determined. Conclusions: ART provides significant benefits for children in this rural African setting, but the finding that a large proportion of children had virologic failure and developed major drug-resistance mutations on first-line ART is worrying. Causes of failure need to be analyzed and effective prevention strategies are needed. Because of the lack of a correlation between immunologic and virologic failure, treatment failure generally stays unnoticed in settings where HIV-RNA testing is not available. © 2010 Lippincott Williams & Wilkins.
Authors & Co-Authors
Barth, Roos E.
Netherlands, Utrecht
University Medical Center Utrecht
Tempelman, Hugo A.
South Africa
Ndlovu Medical Centre
Smelt, Elbert
Netherlands, Utrecht
University Medical Center Utrecht
Wensing, Annemarie Marie J.
Netherlands, Utrecht
University Medical Center Utrecht
Hoepelman, Andy I.M.
Netherlands, Utrecht
University Medical Center Utrecht
Geelen, Sibyl P.M.
Netherlands, Utrecht
Wilhelmina Kinderziekenhuis
Statistics
Citations: 67
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1097/INF.0b013e3181ed2af3
ISSN:
08913668
e-ISSN:
15320987
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa