Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with human immunodeficiency virus in Latin America

Abstract

Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of HIV-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with HIV viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable' viral load (<400 copies/mL). At enrollment, 90.8% of participants were perfectly (100%) adherent, compared to 87.6% at the 6-month and 92.0% at the 12-month visit; the proportion with perfect adherence did not differ over time (p=0.1). Perfect adherence was associated with a higher probability of undetectable viral load at the 12-month visit (odds ratio=4.1, 95% confidence interval: 1.8–9.1; p<0.001), but not at enrollment or the 6-month visit (p>0.3). Last time missed any antiretroviral therapy dose was reported as "never" for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p<0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p≤0.005), but not at the 6-month visit (p=0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population.

Antiretroviral Treatment and Resistance Patterns in HIV-Infected Children

“…A multi-centre research conducted in three Latin American countries measured ART adherence levels and assessed the ability of the adherence measures to predict viral suppression in HIV-infected children. Many of the fully adherent children had detectable VLs, perhaps as a result of previous sub-therapeutic concentrations that led to ARV resistance and sub-optimal suppression of HIV replication while some of the children who were non-adherent had undetectable VLs [43]. ART adherence findings showed the association with VL in the study participants.…”

“…ART adherence findings showed the association with VL in the study participants. However, this association may not be sufficient to clearly identify non-adherence and those at risk of developing viral resistance [43].…”

An update on the HIV treatment cascade in children and adolescents

“…2) [60,61,63,[65][66][67][68][69][70][71][72]. The rates must be viewed with some reservation as methods and numbers differ, and there may be an overestimation using recall and pill counts.…”

Análisis genético de las mutaciones presentes en las poblaciones virales en pacientes con infección por VIH-1 en Ecuador

“…Las opciones terapéuticas en los niños son limitadas pues no todos los medicamentos tienen formulaciones pediátricas y existe el inconveniente de la transmisión de cepas resistentes de la madre al feto 33,34 . Los estudios de resistencia en población pediátrica son necesarios, tanto para aquellos niños tratados con falla a la terapia, como en aquellos que se comenzarán a tratar, para iniciar una terapia de primera línea altamente efectiva 33,34 .…”

“…Las opciones terapéuticas en los niños son limitadas pues no todos los medicamentos tienen formulaciones pediátricas y existe el inconveniente de la transmisión de cepas resistentes de la madre al feto 33,34 . Los estudios de resistencia en población pediátrica son necesarios, tanto para aquellos niños tratados con falla a la terapia, como en aquellos que se comenzarán a tratar, para iniciar una terapia de primera línea altamente efectiva 33,34 . Para realizar un estudio con el objetivo de conocer los mutantes virales y su asociación con los niveles de resistencias a los ARV, es necesario realizar un análisis a un mayor número de muestras, contando con los datos clínicos, terapéuticos y epidemiológicos de todos ellos.…”