Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term effectiveness of combination antiretroviral therapy and prevalence of HIV drug resistance in HIV-1-infected children and adolescents in Rwanda
Pediatric Infectious Disease Journal, Volume 33, No. 1, Year 2014
Notification
URL copied to clipboard!
Description
OBJECTIVE: To determine the long-term outcomes of treatment and prevalence of genotypic drug resistance in children and adolescents on combination antiretroviral therapy. METHODS: A cross-sectional study (September 2009 to October 2010) in which clinical, immunologic and virologic outcomes were assessed at a single-study visit and through patient records in a cohort of HIV-infected children and adolescents. Risk factors for clinical and immunologic responses and virologic outcome were evaluated using logistic regression, and the accuracy of clinical and immunologic criteria in identifying virologic failure was assessed. RESULTS: Four hundred twenty-four patients were enrolled with a median age of 10.8 years (range: 1.7-18.8) and a median duration on combination antiretroviral therapy of 3.4 years (range: 1.0-8.1). Thirty-three percent were stunted and 17% underweight. Eighty-four percent (95% confidence interval: 79-87) of children >5 years had CD4 ≥350 cells/mm and in 74% (95% confidence interval: 62-84) of younger children CD4% was ≥25. CD4 values and age at combination antiretroviral therapy initiation were independently associated with CD4 outcomes; 124 (29%) had HIV-1 RNA ≥1000 copies/mL, with no significant predictors. Sensitivity for weight-for-age and height-for-age and CD4 cells (<350/mm) remained under 50% (15-42%); CD4 cells showed the best specificity, ranging from 91% to 97%. Of 52 samples tested, ≥1 mutations were observed in 91% (nucleoside reverse transcriptase inhibitors) and 95% (non-nucleoside reverse transcriptase inhibitors); 1 to 2 thymidine analogue-associated mutations were detected in 16 (31%) and ≥3 thymidine analogue-associated mutations in 7 (13%). CONCLUSION: Nearly 1 in 3 children showed virologic failure, and >10% of the subgroup of children with treatment failure in whom genotyping was performed demonstrated multiple HIV drug resistance mutations. Neither clinical condition nor CD4 cells were good indicators for treatment failure. Copyright © 2013 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Mutwa, Philippe Rutwaza
Rwanda, Kigali
Centre Hospitalier Universitaire de Kigali
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Boer, Kimberly Rachel
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, Amsterdam
Royal Tropical Institute - Kit
Rusine, John B.
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Rwanda, Kigali
National Reference Laboratory
Muganga, Narcisse
Rwanda, Kigali
Centre Hospitalier Universitaire de Kigali
Tuyishimire, Diane
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Rwanda, Kigali
Treatment and Research on Hiv/aids Centre Trac-plus
Schuurman, Rob J.
Netherlands, Utrecht
University Medical Center Utrecht
Reiss, Peter
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Lange, Joep M.A.
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Geelen, Sibyl P.M.
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, Utrecht
Wilhelmina Kinderziekenhuis
Statistics
Citations: 38
Authors: 9
Affiliations: 8
Identifiers
Doi:
10.1097/INF.0b013e31829e6b9f
ISSN:
08913668
e-ISSN:
15320987
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Rwanda