Abstract
BackgroundChildren living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana.MethodsA cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression.ResultsThe mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04–6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58–15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92–126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58–1.15], p = 0.005).ConclusionThe prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.
Highlights
Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART)
The primary goal of ART is to suppress viral replication, which results in restoration of the immune system, reduction in HIV transmission and a general improvement in the quality of life of people infected with HIV [3, 4]
The aim of this study was to determine the prevalence of virological nonsuppression and its associated factors among children living with HIV (CLWH) attending a Paediatric HIV clinic at Teaching Hospital in Ghana
Summary
Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The World Health Organization (WHO) in 2013 recommended HIV viral load (HIV VL) monitoring as the gold standard for monitoring ART effectiveness in resource-limited settings [5]. This recommendation was adopted by Ghana in 2016. According to Ghana’s National AIDS Control Programmme (NACP) guidelines, viral load testing is recommended 6 months after initiating ART and therafter annually for people who have achieved virological suppression [6]. People with HIV VL levels > 1000 copies/ml are required to undergo intensified adherence support after which the viral load is repeated 3 months later in order to differentiate poor adherence from treatment failure [6]
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