Abstract
BackgroundSub-Saharan Africa (SSA) alone has nine out of every 10 children living with HIV globally and monitoring in this setting remains suboptimal, even as these children grow older. With scalability of antiretroviral therapy (ART), several HIV-infected children are growing towards adolescence (over 2.1 million), with the potentials to reach adulthood. However, despite an overall reduction in HIV-related mortality, there are increasing deaths among adolescents living with HIV (ADLHIV), with limited evidence for improved policy-making. Of note, strategies for adolescent transition from pediatrics to adult-healthcare are critical to ensure successful treatment response and longer life expectancy. Interestingly, with uptakes in prevention of mother-to-child transmission, challenges in ART programs, and high viremia among children in SSA, the success rate of paediatric ART might be quickly jeopardised, with possible HIV-1 drug-resistance (HIVDR) emergence, especially after years of paediatric ART exposure. Therefore, monitoring ART response in adolescents and evaluating HIVDR patterns might limit disease progression and guide on subsequent ART options for SSA ADLHIV.ObjectivesAmong Cameroonian ADLHIV receiving ART, we shall evaluate the rate of immunovirologic failure, acquired HIVDR-associated mutations, HIV-1 subtype distribution, genetic variability in circulating (plasma) versus archived (cellular) viral strains, and HIVDR early warning indicators (EWIs) at different time-points.MethodsA prospective and observational study will be conducted among 250 ADLHIV (10–19 years old) receiving ART in the centre region of Cameroon, and followed-up at 6 and 12 months after enrollment. Following consecutive sampling at enrolment, plasma viral load and CD4/CD8 count will be measured, and genotypic resistance testing (GRT) will be performed both in plasma and in buffy coat for participants experiencing virological failure (two consecutive viremia > = 1000 copies/ml). Plasma viral load and CD4/CD8 will be monitored for all participants at 6 and 12 months after enrolment. HIVDR-EWIs will be monitored and survival analysis performed during the 12 months follow-up. Primary outcomes are rates of virological failure, acquired-HIVDR, and mortality.DiscussionOur findings will provide evidence-based recommendations to ensure successful transition from paediatrics to adult ART regimens and highlight further needs of active ART combinations, for reduced morbidity and mortality in populations of ADLHIV within SSA.
Highlights
Sub-Saharan Africa (SSA) alone has nine out of every 10 children living with HIV globally and monitoring in this setting remains suboptimal, even as these children grow older
Out of about three million children are living with HIV, an estimated 2.1 million were adolescents living with HIV (ADLHIV) (10–19 years of age) in resource-limited settings (RLS) by end 2012, with a consistent rising of HIV-related deaths in these ADLHIV even though regressions are seen in other target populations [5]
Our research objectives will help in generating evidence for optimal monitoring and management of adolescents treated with antiretroviral therapy (ART) in a subSaharan African (SSA) context
Summary
Sub-Saharan Africa (SSA) alone has nine out of every 10 children living with HIV globally and monitoring in this setting remains suboptimal, even as these children grow older. With about 86.4% of the 220, 000 newly infected children worldwide by end 2014 [1], the number of children living with HIV/AIDS will continuously increase overtime, thereby predicting a growing rate of adolescents living with HIV (ADLHIV) in this region. In this line, the burden of HIV/AIDS constitutes a continuous major threat for the future development of SSA countries, and remains a leading poverty-related disease in the entire continent [1,2,3]. ADLHIV constitutes an HIV population with growing health concerns and with very limited findings for generalisable best practices specific to this target population, especially in SSA whereby, compared to the western world, there is persistent suboptimal monitoring strategies in routine practice [6,7,8]
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