Early Response to Highly Active Antiretroviral Therapy in HIV-1-Infected Kenyan Children

Wamalwa, Dalton; Farquhar, Carey; Obimbo, Elizabeth; Selig, Sara; Mbori‐Ngacha, Dorothy; Richardson, Barbra A.; Overbaugh, Julie; Emery, Sandy; Wariua, Grace; Gichuhi, Christine; Bosire, Rose; John‐Stewart, Grace

doi:10.1097/qai.0b013e318042d613

Cited by 106 publications

(104 citation statements)

References 21 publications

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“…This was similar to the reported rate in some other resource limited settings were HIV RNA VL assays was not routinely used in the monitoring of patients on ART; 13% in Uganda children [9], 16% in South Africa [21], 16% in Thailand [22], but fair much lower than 33% in Kenya [23], and 44% in Mali [24]. It was however higher than 9.1% reported from another South African study [25], and 0.8% from a multicenter study in Africa and Asia [26].…”

Section: Discussionsupporting

confidence: 67%

“…Failure to 1 st line ART has been documented in 13% of HIV-infected Uganda children [9], 16% in South Africa [21], 16% in Thailand [22], 33% in Kenya [23], 44% in Mali [24], 9.1% in another South African study [25], and 0.8% from a multi-center study in Africa and Asia [26]. Adherence to ARV therapy has a major role of achieving good viral suppression on HIV patients.…”

Section: Research Articlementioning

confidence: 99%

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First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Aa¹

2015

J HIV Clin Sci Res

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Background: In high-income countries, viral load is routinely used for monitoring HIV patients on antiretroviral therapy for early detection of drug failure. This is not the case in most resource limited settings like ours where only WHO immunological and clinical criteria are used for monitoring. This study is aimed at determining the rate/time of failure to 1 st and 2 nd antiretroviral drugs in children in our centers.Method: Is a retrospective study of children ≤18 years switched to 2 nd line antiretroviral regimen and those requiring third line drugs from Jan 2006 to June 2015 in our health institution. Data analysis was conducted using SPSS version 16.0 software and statistical significance set at p < 0.05. Result:Sixteen percent (82/514) of children on 1 st line medication were switched to 2 nd line drugs with switch over rate of 9 persons/year, and 6/82 (7.3%) required 3 rd line medication. The median switch over time was 31.3 months (IQR 26.4-36.2) for 2 nd line medication, and 42.6 months (IQR 40.1-44.3) from time of switch to 2 nd line drugs for those requiring 3 rd line regimen. Over 90% of patients switched to 2 nd line drugs were between 9-18 years, none was an infant. The mean CD4 cell count and viral load before switch to 2 nd line drugs were 109.09±29.23 cell/mm 3 and 180,480.29±35,303 copies/ ml, and 89.42±28.67 cell/mm 3 / 237,337.5±64,619 copies/ml for those requiring 3 rd line medications. There was over 450 fold increase in viral load from the expected undetectable level of 400 copies/ml after 6 months on medication before patients were switch to 2 nd line drugs, and over 590 folds increase for those that require 3 rd line medications. Significant difference was seen in the mean CD4 cell count and weight of those with adherence of ≥ 95% and ≤ 95% (p values were <0.05). Conclusion:WHO immunological and clinical criteria were found not to be ideal for monitoring of children on antiretroviral therapy. Six monthly viral load monitoring and resistance testing should be introduced in Nigerian guideline for managing HIV children for better therapeutic and pharmacoeconomic outcomes. Third line medication should also be made available in the country and intensification of adherence is required in adolescent age group.

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Section: Discussionsupporting

confidence: 67%

Section: Research Articlementioning

confidence: 99%

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Aa¹

2015

J HIV Clin Sci Res

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“…11 Furthermore, a large proportion of HIV-infected children (13-53%) are expected to experience virological failure within the first year of treatment and are therefore at a higher risk of developing drug resistance if failure is diagnosed late. 7,10,[12][13][14] Such resistance may have important consequences for second-line treatment strategies, particularly in children with reduced treatment options and formularies.…”

Section: Introductionmentioning

confidence: 99%

Extensive Drug Resistance in HIV-Infected Cambodian Children Who Are Undetected as Failing First-Line Antiretroviral Therapy by WHO 2010 Guidelines

Coetzer

Westley

DeLong

et al. 2013

AIDS Research and Human Retroviruses

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Antiretroviral therapy in resource-limited settings is monitored clinically and immunologically according to WHO guidelines. Frequent misclassification of virologic failure is reported, mostly in adults, leading to early therapy switch or late failure diagnosis. Pediatric treatment monitoring and resistance data upon first-line failure are limited, particularly when the 2010-WHO pediatric guidelines are used without routine viral load monitoring. We previously reported high treatment failure misclassification rates by pediatric 2010 guidelines in Cambodian children on first-line therapy. Here we determine the extent and patterns of resistance, with yearly viral load and 6-monthly CD4. Drug resistance mutations were determined using the IAS-USA 2011 list. Predicted resistance interpretation was determined with Stanford Database tools. Fifty-one children with available genotypes met inclusion criteria. All but one (subtype B) were CRF01_AE. The most common regimen was stavudine, lamivudine, and nevirapine (96%), taken for a median of 2.2 years. Resistance was seen in 98%; 96% to nucleoside and nonnucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs); 51% with ‡ 4 mutations. The most common NRTI mutations were 184V/I and 67N and the most common NNRTI mutations were 181C/Y/I/V and 190A/S. A total of 22% had multiresistant mutations and 18% had predicted high-level resistance to subsequent therapy options didanosine, abacavir, etravirine, and tenofovir. In 98% of Cambodian children misclassified as nonfailing first-line therapy by 2010 guidelines, 51% had extensive drug resistance to current and 18% to subsequent antiretroviral therapy. Affordable routine viral load monitoring allowing for early and more accurate treatment failure diagnosis is desperately needed in resource-limited settings.

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“…Considerable efforts to control the spread of HIV in the region have been made with an increasingly higher number of people receiving free combined antiretroviral therapy (cART) (Joint United Nations Programme on HIV/AIDS & World Health Organization 2009; World Health Organization, United Nations Children's Fund, UNAIDS 2009). As a result, mortality and morbidity rates among HIV-infected children have significantly reduced (Bolton-Moore, Mubiana-Mbewe, Cantrell, Chintu, Stringer, Chi, et al 2007;Ellis & Molyneux 2007;Janssen, Ndirangu, Newell & Bland 2010;Kiboneka, Wangisi, Nabiryo, Tembe, Kusemererwa, Olupot-Olupot, et al 2008;KIDS-ART-LINC Collaboration 2009;Nyandiko, Ayaya, Nabakwe, Tenge, Sidle, Yiannoutsos, et al 2006;Puthanakit, Aurpibul, Oberdorfer, Akarathum, Kanjananit, Wannarit, et al 2007;Wamalwa, Farquhar, Obimbo, Selig, Mbori-Ngacha, Richardson, et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Wachira

Middlestadt²,

Vreeman³

et al. 2012

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya.Methods: Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIVinfected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed.Results: Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care. Conclusion:The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended.Keywords: HIV care, loss to follow-up in children, caregivers. RésuméObjectif : Dans l'objectif de réduire les perdus de vue pédiatriques dans les programmes de prise en charge clinique du VIH en Afrique subsaharienne, nous avons cherché à comprendre les facteurs personnels et socioculturels associés au comportement des aidants emmenant les enfants séropositifs et exposés au VIH à leurs sessions de traitement à l'Ouest du Kenya.Méthodes : De mai à août 2010, des entretiens détaillés ont été menés auprès de 26 aidants sélectionnés à cette fin en charge d'enfants séropositifs (7), exposés au VIH (17) et de statut sérologique inconnu (2), documentés comme perdus de vue à partir d'un centre de traitement du VIH urbain et rural. Tous étaient des femmes, et une majorité d'entre elles (77 %) étaient les parents biologiques de ces enfants. Les entretiens ont été enregistrés sur cassette, retranscrits et leur contenu analysés.Résultats : L'analyse thématique du contenu des perceptions des femmes a révélé que leurs décisions quant au fait d'emmener leurs enfants en traitement pour le VIH impliquaient des facteurs ...

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Early Response to Highly Active Antiretroviral Therapy in HIV-1-Infected Kenyan Children

Abstract: Good early clinical and virologic response to NNRTI-based HAART was observed in HIV-1-infected Kenyan children with advanced HIV-1 disease.

Cited by 106 publications

References 21 publications

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Extensive Drug Resistance in HIV-Infected Cambodian Children Who Are Undetected as Failing First-Line Antiretroviral Therapy by WHO 2010 Guidelines

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

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