Determinants of switch to paediatric second‐line antiretroviral therapy after first‐line failure in Cameroon

Abstract

Objective With scale‐up of antiretroviral therapy (ART) children, treatment failure and switch to subsequent ART regimens are common. Our objectives were to evaluate switching practices and identify factors associated among children and adolescents failing their first‐line ART. Methods A facility‐based survey study was conducted in a cohort of children living with HIV experiencing virological failure (VF) at the Essos Hospital Centre of Yaounde, Cameroon. Data were collected using a standard questionnaire, and key variables were as follows: (a) VF defined as viral load (VL) > 1000 copies/ml, (b) rate of switch to second‐line and (c) reason(s) for switching ART. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the association between study variables, and P < 0.05 was considered statistically significant. Results A total of 106 children experiencing VF were enrolled: median age was 8 [interquartile range (IQR): 3–15] years; 60.38% were boys and 39.62% were orphans of one/both parents. A proportion of 69% were at the WHO clinical stage III/IV, and 13.21% were experiencing immunological failure (CD4 < 200 cells/mm3). The median duration on first‐line ART was 36 [IQR: 7–157] months prior to detecting VF, and the rate of switch to second‐line ART was 70.75% (75/106). Delay in switching ART after a confirmed VF was 11 [IQR: 7–16] months. After switch to second‐line ART, the median time to achieve undetectable VL (<40 copies/ml) was 14 [IQR: 9–21] months. Multivariate analysis revealed that only children with viral rebound (aOR = 0.09; 95% CI = 0.03–0.24) were less likely to be switched. Of note, being orphaned (aOR = 0.35, CI = 0.11–1.11), biological sex (aOR = 1.77, CI = 0.60–5.29) and immune status (aOR = 0.19, CI = 0.03–1.31, 0.09) had no significant effect on switching to second‐line ART. Conclusion In this paediatric population experiencing VF after about 3–4 years from ART initiation, the majority are switched to second‐line ART after a delay of almost one year. Delayed switch to second‐line was driven essentially by viral rebound, underscoring the need for close viral monitoring.

Incidence of switching to second-line antiretroviral therapy and its predictors among children on antiretroviral therapy at general hospitals, Northern Ethiopia: A survival analysis

“…The study finding also revealed that being an orphan child was significantly associated with second-line switch. The findings of a recent pediatric study conducted in Cameroon supported this association [33]. Children are dependent on their parents and require continual support due to their age and developmental stages.…”

CHAPAS-4 trial: second-line anchor drugs for children with HIV in Africa

“…Globally, numbers of children living with HIV (CLHIV) accessing first-line antiretroviral therapy (ART) have increased; coupled with increasing HIV viral load (VL) monitoring, numbers requiring second-line and subsequent ART following virological failure will also increase. 1–3 The majority of CLHIV live in Africa and until recently first-line non-nucleoside-reverse-transcriptase (NNRTI)-containing regimens were most frequently used. 3 For second-line ART following NNRTI failure, guidelines recommend an anchor drug from a new class (boosted protease inhibitor (bPI) or integrase inhibitor (INSTI)), combined with 2 nucleoside-reverse-transcriptase-inhibitors (NRTIs).…”