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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana
BMC Infectious Diseases, Volume 13, No. 1, Article 476, Year 2013
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Description
Background: Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load. Methods: We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis. Results: Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with ≥ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child's gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes. Conclusions: First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries. © 2013 Barry et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Barry, Oliver M.
United States, New York
Columbia University
Powell, Jonathan
United States, New York
Weill Cornell Medicine
A Renner, Lorna
Ghana, Accra
University of Ghana
Bonney, Evelyn Yayra A.
Ghana, Accra
Noguchi Memorial Institute for Medical Research
Prin, Meghan
United States, New York
Columbia University
Ampofo, William Kwabena
Ghana, Accra
Noguchi Memorial Institute for Medical Research
Kusah, Jonas Tettey
Ghana, Accra
University of Ghana
Goka, Bamenla Quarm
Ghana, Accra
University of Ghana
Sagoe, Kwamena William Coleman
Ghana, Accra
University of Ghana
Shabanova, Veronika S.
United States, New Haven
Yale School of Medicine
Paintsil, Elijah
United States, New Haven
Yale School of Medicine
Statistics
Citations: 50
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1186/1471-2334-13-476
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Ghana