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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Prevalence and determinants of virological failure in HIV-infected children on antiretroviral therapy in rural Cameroon: A cross-sectional study
Antiviral Therapy, Volume 18, No. 5, Year 2013
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Description
Background: In Africa, success of antiretroviral treatment (ART) seems to lag behind in children compared with adults, and high therapeutic failure rates have been reported. We aimed to identify prevalence and determinants of virological failure in HIV-infected children treated under programmatic conditions. Methods: All patients <18 years on ART presenting to the HIV clinic at the Bamenda Regional Hospital, a secondary referral hospital in rural Cameroon, from September 2010 to August 2011, were enrolled in this cross-sectional study. Clinical data, self-reported adherence, CD4+s T-cell counts and viral load were recorded. Therapeutic drug monitoring was performed on stored plasma samples. Determinants of virological failure were identified using descriptive statistics and logistic regression. Results: A total of 230 children with a mean age of 8.9 years (sd 3.7) were included. At the time of analysis, the mean duration of HAART was 3.5 years (sd 1.7) and 12% had a CD4+T-cell count <200 cells/μl. In total, 53% of children experienced virological failure (>200 copies/ml). Among children on nevirapine (NVP), plasma levels were subtherapeutic in 14.2% and supratherapeutic in 42.2%. Determinants of virological failure included male sex, lower CD4+ T-cell counts, subtherapeutic drug levels, longer time on ART and a deceased mother. Poor adherence was associated with subtherapeutic NVP plasma levels and advanced disease stages (WHO stage 3/4). Conclusions: This study demonstrates high virological failure rates and a high variability of NVP plasma levels among HIV-infected children in a routine ART programme in rural Cameroon. Strategies to improve adherence to ART in HIV-infected children are urgently needed. © 2013 International Medical Press.
Authors & Co-Authors
Zoufaly, Alexander
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Fillekes, Quirine
Netherlands, Nijmegen
Radboud University Medical Center
Hammerl, Raffaela
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Germany, Hamburg
Bernhard Nocht Institut Fur Tropenmedizin Hamburg
Nassimi, Nilofar
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Germany, Hamburg
Bernhard Nocht Institut Fur Tropenmedizin Hamburg
Jochum, Johannes
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Drexler, Jan Felix
Germany, Bonn
Universität Bonn
Awasom, Charles N.
Cameroon, Yaounde
Bamenda Regional Hospital
Sunjoh, Frida L.
Cameroon, Yaounde
Bamenda Regional Hospital
Burchard, Gerd Dieter
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Germany, Hamburg
Bernhard Nocht Institut Fur Tropenmedizin Hamburg
Burger, David Marinus
Netherlands, Nijmegen
Radboud University Medical Center
van Lunzen, Jan
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Feldt, Torsten
Germany, Hamburg
Bernhard Nocht Institut Fur Tropenmedizin Hamburg
Germany, Dusseldorf
Universitätsklinikum Düsseldorf
Statistics
Citations: 40
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.3851/IMP2562
ISSN:
13596535
e-ISSN:
20402058
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Cameroon
Participants Gender
Male