Long-term Outcome of Children Receiving Antiretroviral Treatment in Rural South Africa

Barth, Roos E.; Tempelman, Hugo; Smelt, Elbert; Wensing, Annemarie M. J.; Hoepelman, Andy I. M.; Geelen, Sibyl P. M.

doi:10.1097/inf.0b013e3181ed2af3

Cited by 57 publications

(60 citation statements)

References 31 publications

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“…Unsuppressed viremia leads to accumulation of resistance mutations and patients monitored by clinical or immunologic criteria tend to have increased durations of unsuppressed viremia compared to those monitored with viral load [5]. Despite this limitation, a majority of adults in resource-limited settings have attained virologic suppression on second-line regimens, even in the context of clinical or immunologically driven monitoring strategies [6],[7].…”

Section: Introductionmentioning

confidence: 99%

Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up

et al. 2014

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BackgroundIn Tanzania, HIV-1 RNA testing is rarely available and not standard of care. Determining virologic failure is challenging and resistance mutations accumulate, thereby compromising second-line therapy. We evaluated durability of antiretroviral therapy (ART) and predictors of virologic failure among a pediatric cohort at four-year follow-up.MethodsThis was a prospective cross-sectional study with retrospective chart review evaluating a perinatally HIV-infected Tanzanian cohort enrolled in 2008-09 with repeat HIV-1 RNA in 2012-13. Demographic, clinical, and laboratory data were extracted from charts, resistance mutations from 2008-9 were analyzed, and prospective HIV RNA was obtained.Results161 (78%) participants of the original cohort consented to repeat HIV RNA. The average age was 12.2 years (55% adolescents ≥12 years). Average time on ART was 6.4 years with 41% receiving second-line (protease inhibitor based) therapy. Among those originally suppressed on a first-line (non-nucleoside reverse transcriptase based regimen) 76% remained suppressed. Of those originally failing first-line, 88% were switched to second-line and 72% have suppressed virus. Increased level of viremia and duration of ART trended with an increased number of thymidine analogue mutations (TAMs). Increased TAMs increased the odds of virologic failure (p = 0.18), as did adolescent age (p < 0.01).ConclusionsAfter viral load testing in 2008-09 many participants switched to second-line therapy. The majority achieved virologic suppression despite multiple resistance mutations. Though virologic testing would likely hasten the switch to second-line among those failing, methods to improve adherence is critical to maximize durability of ART and improve virologic outcomes among youth in resource-limited settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0567-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up

et al. 2014

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“…In [11] As evidence mounts for successful initiation of paediatric ART care in rural and urban community-based PHC clinics, [13][14][15][16][17][18] the need to evaluate paediatric down-referral outcomes remains. A systematic review of decentralised HIV care (including three studies with paediatric data) demonstrated comparable outcomes, with similar or reduced patient attrition and death at 12 months.…”

mentioning

confidence: 99%

Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Morsheimer

Dramowski

Rabie

et al. 2014

South. Afr. j. HIV med.

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Background. Although subSaharan Africa faces the world's largest paediatric HIV epidemic, only 1 in 4 children has access to combination antiretroviral therapy (ART). A decentralised approach to HIV care is advocated, but programmes in resourcelimited settings encounter many challenges to community-initiated paediatric ART implementation. + , viral load (VL) levels and status at study closure were collected. Results. Two subgroups were identified: children who were initiated on ART in a PHC clinic (n=343) and children who were down-referred from tertiary hospitals (n=270). The numbers of children initiated on ART in PHC increased sevenfold over the study period. Down-referred children were severely ill at ART initiation, with higher VLs, lower CD4 + counts and higher rates of tuberculosis co-infection (25.3% v. 16.9%; p=0.01). Median time to virological suppression was 29 weeks in PHC-ART initiates and 44 weeks in children down-referred (p<0.0001). Children down-referred to PHC either maintained or gained virological suppression. Longitudinal cohort analysis demonstrated sustained VL suppression >80%, high rates of immune reconstitution and low mortality. Conclusions. Increasing numbers of children are initiated on ART in PHC settings and achieve comparable immunological, virological and survival outcomes, suggesting successful decentralisation of paediatric HIV care. Down-referral of children with adherence-related virological failure may assist with attainment of virological suppression and sparing use of second-line medications.

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“…A recent retrospective study implemented in another rural area of South Africa found similar rates (38%) of virological failure (median duration since beginning HAART of 31 months) [13].…”

Section: Discussionmentioning

confidence: 84%

“…Between 2005 and 2014, children treated with HAART increased from 71.500 to 824.000 [11] but long-term (>3 years) virological and immunological data collected in Sub-Saharan Africa are scarce [12][13][14][15][16]. Children are at risk to develop treatment failure due to inappropriate antiretroviral formulations, adherence difficulties, drug toxicity or development of resistance [17].…”

Section: Introductionmentioning

confidence: 99%

Virological and Immunological Long-Term Outcome of Human Immunodeficiency Virus-1 Infected Children Treated before One Year and after Two Years of Age in a Resource-Limited Setting of South Africa

J¹,

Ruelle²,

Goubau³

et al. 2017

J AIDS Clin Res

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Long-term Outcome of Children Receiving Antiretroviral Treatment in Rural South Africa

Cited by 57 publications

References 31 publications

Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up

Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up

Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Virological and Immunological Long-Term Outcome of Human Immunodeficiency Virus-1 Infected Children Treated before One Year and after Two Years of Age in a Resource-Limited Setting of South Africa

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