Factors associated with the failure of first and second-line antiretroviral therapies therapy, a case control study in Cambodian HIV-1 infected children

Abstract

BackgroundLittle is known about the efficacy of first and and second-line antiretroviral therapies (ART) for HIV-1 infected children in resource limited Southeast Asian settings. Previous studies have shown that orphans are at a higher risk for virological failure (VF) in Cambodia. Consequently most of them required transfer to second-line ART. We assessed the factors associated with VF among HIV-1 infected children who were either under first-line (mostly 3TC + D4T + NVP) or under second-line (mostly ABC + DDI + LPV) therapies at a referral hospital in Cambodia.MethodsA case-control study was conducted from February to July 2013 at the National Pediatric Hospital among HIV-1 infected children (aged 1–15 years) under second-line ART (cases) or first-line (matched controls at a ratio of 1:3) regimens. Children were included if a HIV-1 RNA plasma viral load (VL) result was available for the preceding 12 months. A standardized questionnaire explored family sociodemographics, HIV history, and adherence to ART. Associations between VF (HIV-1 RNA levels ≥1000 copies/ml) and the children’s characteristics were assessed using bivariate and multivariate analyses.ResultsA total of 232 children, 175 (75.4 %) under first-line and 57 (24.6 %) under second-line ART, for a median of 72.0 (IQR: 68.0–76.0) months, were enrolled. Of them, 94 (40.5 %) were double orphans and 51 (22.0 %) single orphans, and 77 (33.2 %) were living in orphanages. A total of 222 children (95.6 %) were deemed adherent to ART. Overall, 18 (7.7 %; 95 % CI 4.6–11.9) showed a VF, 14 (8.6 %; 95 % CI 4.8–14.0) under first-line and 4 (7.0 %; 95 % CI 1.9–17.0) under second-line ART (p = 0.5). Their median CD4 percentage was 8 % (IQR 2.9–12.9) at ART initiation. Children under second-line ART were older; more often double orphans, and had lower CD4 cell counts at the last control.In the multivariate analysis, having the last CD4 percentage below 15 % was the only factor associated with VF for ART regimen separately or when combined (OR 40.4; 95 % CI 11–134).ConclusionsThe pattern of risk factors for VF in children is changing in Cambodia. Improved adherence evaluation and intensified monitoring of children with low CD4 counts is needed to decrease the risk of VF.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-1884-y) contains supplementary material, which is available to authorized users.

Incidence and risk factors of first-line antiretroviral treatment failure among human immunodeficiency virus-infected children in Amhara regional state, Ethiopia: a retrospective follow-up study

“…This study showed that the baseline CD4 count was not a predictor of treatment failure. This was in contrast with the result of studies done in Addis Ababa, 18 Cambodia 29 and Thailand, 33 but consistent with the study conducted among Ugandan children. 28 This might be due to the high public health advocated approach to ART nowadays, which substantially increased the awareness of healthcare providers and caregivers.…”

“… 19 Moreover, this study showed a lower failure rate than other studies done in Africa, for example Nigeria (18.8%), 13 Uganda (34%), 28 a combined study from Mozambique-Uganda (29%) 16 and Cambodia (8.6%). 29 However, the result was higher than the result in India of 5.1%. 30 This may be due to improvements of healthcare services in the later periods of follow-up as compared with earlier periods.…”

Virological failure and its predictors among human immunodeficiency virus infected individuals on second line antiretroviral treatment in North‐East Ethiopia, 2021

“…This result was consistent with previous studies conducted in Asia and Sub‐Saharan Africa (16.4%), 34 Rwanda (17%) 35 and Gondar (14.7%) 20 but higher than studies conducted in Asia‐Pacific sites (7%), 36 Cambodian (7%), 37 Malawi (9.3%), 38 and in Ethiopia (13.6%) 14 and it was Lower than studies conducted in Thailand (49%), 39 Vietnam (22.8%), 10 Uganda (23%), 40 and Ethiopia (25.11%) 41 and (18.4%) 42 . The higher magnitude of VF in this study could be attributed to the difference in the studied populations which were the inclusion of individuals who were on PI‐based regimen only or studied children or adults above the age of 18 and the use of clinical and immunological criteria to define TF which are less specific and sensitive measures 14,36–38 . The low prevalence of VF in this study might be due to those studies involved only PI‐based children, the use of death as an additional criterion to define TF, exclusion of patients who did not have baseline viral load at SLART initiation and who had regimen change 10,39–42 …”

Determinants of Virological Failure Among HIV-Infected Children on First-Line Antiretroviral Therapy in West Gojjam Zone, Amhara Region, Ethiopia

“…11 Studies show that virological failure occurs due to factors, such as being male in gender, [12][13][14][15] age < 3 years, [16][17][18] being orphaned, 14,15 non-disclosure, 15,19 poor adherence, 15,17,20,21 has not being on ART for a long period 13 and take ART suboptimal. 12 In addition, opportunistic infections, [15][16][17]19,20,22,23 malnutrition, 14,16 were WHO stage 3 and 4, 15,24 lower CD4 count (Cells/ mL), 12,15,16,20,[24][25][26] initial viral load >1000 copies/ mL, 21,27 D4T/3TC/NVP based regimen, 21,22,[28][29][30] regimen change, 14,15 longer duration on ART, 15,31 treatment interruption, 12,…”