Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania.

Autor: Khamadi SA; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Bahemana E; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Dear N; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Mavere C; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., George F; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Kapene R; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Papianus G; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Willoughby W; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Chambers J; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Ganesan K; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Mwakabanje I; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Bacha JM; Baylor College of Medicine, Department of Pediatrics, Houston, Texas, USA.; Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania., Desai P; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Almas S; Walter Reed Program/HJF Medical Research International, Mbeya, Tanzania., Coakley PD; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Wolfman V; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA., Lee EH; The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA., Hickey PW; The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA., Livezey J; The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA., Agaba PA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
Jazyk: angličtina
Zdroj: Journal of the Pediatric Infectious Diseases Society [J Pediatric Infect Dis Soc] 2023 Jun 30; Vol. 12 (6), pp. 353-363.
DOI: 10.1093/jpids/piad040
Abstrakt: Background: Achieving viral suppression (VS) for persons living with HIV is key to reaching epidemic control. We assessed the prevalence of VS and the frequency of HIV drug resistance mutations (HIVDRM) among children and adolescents living with HIV (CALHIV) in the Southern Highland zone of Tanzania.
Methods: From 2019 to 2021, we enrolled CALHIV aged 1-19 years on ART for >6 months in a cross-sectional study. Participants had viral load (VL) testing; those with VL ≥ 1000 copies/mL underwent HIVDRM testing. VS (<1000 copies/mL) prevalence estimates were calculated and robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations with potential predictors of VS.
Results: Of 707 participants, 595 had VS (PR: 0.84, 95% CI: 0.81-0.87). Use of an integrase strand transfer inhibitor-containing regimen (aPR 1.15, 95% CI: 0.99-1.34), age 5-9 years (aPR 1.16, 95% CI: 1.07-1.26), and seeking care at a referral center (aPR 1.12, 95% CI: 1.04-1.21) were associated with VS. Factors inversely associated with VS included having one (aPR 0.82, 95% CI: 0.72-0.92) or two or more (aPR 0.79, 95% CI: 0.66-0.94) referrals for adherence counselling, and self-reporting missing one to two (aPR 0.88, 95% CI: 0.78-0.99) or three or more (aPR 0.77, 95% CI: 0.63-0.92) doses of ART in the past month. Of 74 participants with PRRT and INT sequencing done, 60 (81.1%) had HIVDRMs at the following frequencies: 71.6%, 67.6%, 1.4%, and 4.1% for major NNRTI, NRTI, PI, and INSTI respectively.
Conclusions: Higher rates of VS were observed in this cohort, and HIVDRMs were common in those without VS. This evidence supports ART optimization using dolutegravir-based regimens. However, better strategies to improve adherence are needed.
(© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society.)
Databáze: MEDLINE
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