Dataset Information

Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.

ABSTRACT:

Objective

To investigate the prevalence and determinants of virologic failure and acquired drug resistance-associated mutations (DRMs) in HIV-infected children and adolescents in rural Tanzania.

Design

Prospective cohort study with cross-sectional analysis.

Methods

All children 18 years or less attending the paediatric HIV Clinic of Ifakara and on antiretroviral therapy (ART) for at least 12 months were enrolled. Participants with virologic failure were tested for HIV-DRM. Pre-ART samples were used to discriminate acquired and transmitted resistances. Multivariate logistic regression analysis identified factors associated with virologic failure and the acquisition of HIV-DRM.

Results

Among 213 children on ART for a median of 4.3 years, 25.4% failed virologically. ART-associated DRM were identified in 90%, with multiclass resistances in 79%. Pre-ART data suggested that more than 85% had acquired key mutations during treatment. Suboptimal adherence [odds ratio (OR)?=?3.90; 95% confidence interval (CI) 1.11-13.68], female sex (aOR?=?2.57; 95% CI 1.03-6.45), and current nonnucleoside reverse transcriptase inhibitor-based ART (aOR?=?7.32; 95% CI 1.51-35.46 compared with protease inhibitor-based) independently increased the odds of virologic failure. CD4 T-cell percentage (aOR?=?0.20; 0.10-0.40 per additional 10%) and older age at ART initiation (aOR?=?0.84 per additional year of age; 95% CI 0.73-0.97) were protective (also in predicting acquired HIV-DRM). At the time of virologic failure, less than 5% of the children fulfilled the WHO criteria for immunologic failure.

Conclusion

Virologic failure rates in children and adolescents were high, with the majority of ART-failing children harbouring HIV-DRM. The WHO criteria for immunologic treatment failure yielded an unacceptably low sensitivity. Viral load monitoring is urgently needed to maintain future treatment options for the millions of African children living with HIV.

SUBMITTER: Muri L

PROVIDER: S-EPMC5131685 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Publications

Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.

Muri Lukas L Gamell Anna A Ntamatungiro Alex J AJ Glass Tracy R TR Luwanda Lameck B LB Battegay Manuel M Furrer Hansjakob H Hatz Christoph C Tanner Marcel M Felger Ingrid I Klimkait Thomas T Letang Emilio E

AIDS (London, England) 20170101 1

<h4>Objective</h4>To investigate the prevalence and determinants of virologic failure and acquired drug resistance-associated mutations (DRMs) in HIV-infected children and adolescents in rural Tanzania.<h4>Design</h4>Prospective cohort study with cross-sectional analysis.<h4>Methods</h4>All children 18 years or less attending the paediatric HIV Clinic of Ifakara and on antiretroviral therapy (ART) for at least 12 months were enrolled. Participants with virologic failure were tested for HIV-DRM. ...[more]

PMID: 27677163

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Dataset Information

Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.

Objective

Design

Methods

Results

Conclusion

Publications

Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.

Similar Datasets

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