Rates and Correlates of Short Term Virologic Response among Treatment-Naïve HIV-Infected Children Initiating Antiretroviral Therapy in Ethiopia: A Multi-Center Prospective Cohort Study.

Birkneh Tilahun Tadesse,Chanson J Brumme,Sintayehu Tadesse,Tolosssa Eticha Chaka,Adugna Chala,Zabrina L Brumme,Eleni Aklillu,Eyasu Makonnen,Jackson Mukonzo

doi:10.3390/pathogens8040161

Abstract

There is limited data on virologic outcome and its correlates among HIV-infected children in resource-limited settings. We investigated rate and correlates of virologic outcome among treatment naïve HIV-infected Ethiopian children initiating cART, and were followed prospectively at baseline, 8, 12, 24 and 48 weeks using plasma viral load, clinical examination, laboratory tests and pretreatment HIV drug resistance (PDR) screening. Virologic outcome was assessed using two endpoints–virological suppression defined as having “undetectable” plasma viral load < 150 RNA copies/mL, and rebound defined as viral load ≥150 copies/mL after achieving suppression. Cox Proportional Hazards Regression was employed to assess correlates of outcome. At the end of follow up, virologic outcome was measured for 110 participants. Overall, 94(85.5%) achieved virological suppression, of which 36(38.3%) experienced virologic rebound. At 48 weeks, 9(8.2%) children developed WHO-defined virological treatment failure. Taking tenofovir-containing regimen (Hazard Ratio (HR) 3.1-[95% confidence interval (95%CI) 1.0–9.6], p = 0.049) and absence of pretreatment HIV drug resistance (HR 11.7-[95%CI 1.3–104.2], p = 0.028) were independently associated with earlier virologic suppression. In conclusion, PDR and cART regimen type correlate with rate of virologic suppression which was prominent during the first year of cART initiation. However, the impact of viral rebound in 38.3% of the children needs evaluation.

Highlights

The number of children accessing combination antiretroviral therapy has increased over the past decade following global initiatives including “test and treat” and the ambitious UNAIDS 90-90–90 treatment targets to help end the AIDS epidemic [1,2]
Achieving sustained virologic suppression following initiation of combination antiretroviral therapy (cART) is critical to ensure reduction in mortality and morbidity of HIV infected children, but limited data exist on the rates and correlates of virologic response among HIV-infected children in East and Southern Africa (ESA)
An aggregate estimate of 86% virological suppression in 2016 has been reported, which is higher than the ESA regional average of 52% [33,34,35]

Summary

Introduction

The number of children accessing combination antiretroviral therapy (cART) has increased over the past decade following global initiatives including “test and treat” and the ambitious UNAIDS 90-90–90 treatment targets to help end the AIDS epidemic [1,2]. The 90-90-90 goals, which were originally hoped to be realized by 2020, aim to have 90% of people living with HIV being aware of their diagnosis; 90% of those with diagnosed infection be on sustained antiretroviral treatment, and 90% of those receiving antiretroviral treatment to have virological suppression [3] Though these ambitious goals are critical in decreasing AIDS related morbidity and mortality in resource limited settings, recent data suggest that these targets may possibly be feasible in some settings [4], disparities in the ability of individual countries to perform towards the goals remain substantial [5,6]. Data on the prevalence and impact of pretreatment HIV drug resistance mutations on pediatric firstline antiretroviral treatment regimen efficacy are scarce for resource-limited settings [11,12,13,14]

Methods

Results

Conclusion