Abstract
Sub-Saharan Africa carries the largest burden of pediatric HIV infection. The success of second line anti-retroviral treatment and related factors among African children is not well-defined. Objectives: We aimed to identify the rate and determinants of second line anti-retroviral treatment failure among children and adolescents on follow-up at an Ethiopian tertiary teaching hospital. A retrospective observational cohort study was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa. Structured forms were used to collect socio-demographic, clinical and diagnostic data. Descriptive statistics and bivariate analysis were used to describe the magnitude of the problem and its associations. A total of 76 children and adolescents taking second line anti-retroviral treatment were analyzed (mean age: 16.1 years). Failure of therapy was seen in 14/76 while four were eligible for a switch to third line anti-retrovirals. Mean duration on second line treatment till virologic failure was diagnosed was 17.6 months while mean viral load upon requiring a third line regimen was 82,131.3 copies/ml. Second line antiretroviral treatment virologic failure was significantly associated with the age of the child or adolescent. A high rate of virologic failure exists among the study population. Findings underline need for provision of third line anti-retroviral drugs in Ethiopia. Challenges for delivering a standard care were irregular viral load testing and delayed initiation of second line treatment after failure of first line regimens.
Highlights
Sub-Saharan Africa carries the largest burden of pediatric HIV infection
Our study focused on determining the rate and predictors for treatment failure for second line Anti-retroviral treatment (ART) among children and adolescents living with HIV and on follow-up at Ethiopia’s largest tertiary care referral center – Tikur Anbessa Specialized Hospital located in the capital city of Addis Ababa
None of the pediatric population on second line anti-retroviral drugs (ARVs) had been exposed to ARVs for prevention of mother to child transmission (PMTCT)
Summary
Sub-Saharan Africa carries the largest burden of pediatric HIV infection. The success of second line anti-retroviral treatment and related factors among African children is not well-defined. Objectives: We aimed to identify the rate and determinants of second line anti-retroviral treatment failure among children and adolescents on follow-up at an Ethiopian tertiary teaching hospital. A total of 76 children and adolescents taking second line anti-retroviral treatment were analyzed (mean age: 16.1 years). A systematic review on second-line antiretroviral treatment failure in all age groups in sub-Saharan African showed a pooled rate of 15 per 100 person years – with children, residents of Southern Africa and those on therapy for 12–18 months being at particular risk[7]. Our study focused on determining the rate and predictors for treatment failure for second line ART among children and adolescents living with HIV and on follow-up at Ethiopia’s largest tertiary care referral center – Tikur Anbessa Specialized Hospital located in the capital city of Addis Ababa
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