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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: A cross-sectional study
Journal of Acquired Immune Deficiency Syndromes, Volume 54, No. 4, Year 2010
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Description
Background: Many HIV care and treatment programs in resource-limited settings rely on clinical and immunologic monitoring of antiretroviral therapy (ART), but accuracy of this strategy to detect virologic failure (VF) among children has not been evaluated. Methods: A cross-sectional sample of HIV-infected children aged 1-16 years on ART ≥6 months receiving care at a Tanzanian referral center underwent clinical staging, CD4 lymphocyte measurement, plasma HIV-1 RNA level, and complete blood count. Associations with VF (HIV-1 RNA ≥400 copies/mL) were determined utilizing bivariable and multivariate analyses; accuracy of current clinical and immunologic guidelines in identifying children with VF was assessed. Findings: Of 206 children (median age 8.7 years, ART duration 2.4 years), 65 (31.6%) demonstrated VF at enrollment. Clinical and immunological criteria identified 2 (3.5%) of 57 children with VF on first-line therapy, exhibiting 3.5% sensitivity and 100% specificity. VF was associated with younger age, receipt of nevirapine vs. efavirenz-based regimen, CD4% < 25%, and physician documentation of maladherence (P < 0.05 on bivariable analysis); the latter 2 factors remained significant on multivariate logistic regression. Interpretation: This study demonstrates poor performance of clinical and immunologic criteria in identifying children with virologic failure. Affordable techniques for measuring HIV-1 RNA level applicable in resource-limited settings are urgently needed. © 2010 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Emmett, Susan D.
United States, Durham
Duke University Medical Center
United States, Durham
Duke University
United States, Chevy Chase
Howard Hughes Medical Institute
Cunningham, Coleen K.
United States, Durham
Duke University Medical Center
Mmbaga, Blandina Theophil
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Kinabo, Grace Damas
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Schimana, Werner
United States, Washington, D.c.
Elizabeth Glaser Pediatric Aids Foundation
Swai, Mark E.
United States, Durham
Duke University Medical Center
Bartlett, John A.
United States, Durham
Duke University
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Crump, John A.
United States, Durham
Duke University
United States, Durham
Duke University Medical Center
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Reddy, Elizabeth A.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Statistics
Citations: 84
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1097/QAI.0b013e3181cf4882
ISSN:
15254135
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Tanzania