Prevalence and determinants of virological failure in HIV-infected children on antiretroviral therapy in rural Cameroon: a cross-sectional study
| Autor: | Jan van Lunzen, David M. Burger, Nilofar Nassimi, Charles Awasom, Quirine Fillekes, Torsten Feldt, Gerd D. Burchard, Johannes Jochum, Alexander Zoufaly, Jan Felix Drexler, Raffaela Hammerl, Frida Sunjoh |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Rural Population Pediatrics medicine.medical_specialty Nevirapine Adolescent Anti-HIV Agents Cross-sectional study HIV Infections Medication Adherence Antiretroviral Therapy Highly Active Surveys and Questionnaires Hiv infected Prevalence Advanced disease medicine Humans Pharmacology (medical) Cameroon Child Pharmacology business.industry Infant Newborn Infant Plasma levels Viral Load Virological failure Antiretroviral therapy Cross-Sectional Studies Treatment Outcome Infectious Diseases Child Preschool HIV-1 Therapeutic failure Female business Poverty-related infectious diseases Infectious diseases and international health [N4i 3] medicine.drug |
| Zdroj: | Antiviral Therapy, 18, 681-90 Antiviral Therapy, 18, 5, pp. 681-90 |
| ISSN: | 1359-6535 |
| Popis: | Background In Africa, success of antiretroviral treatment (ART) seems to lag behind in children compared with adults, and high therapeutic failure rates have been reported. We aimed to identify prevalence and determinants of virological failure in HIV-infected children treated under programmatic conditions. Methods All patients + T-cell counts and viral load were recorded. Therapeutic drug monitoring was performed on stored plasma samples. Determinants of virological failure were identified using descriptive statistics and logistic regression. Results A total of 230 children with a mean age of 8.9 years (sd 3.7) were included. At the time of analysis, the mean duration of HAART was 3.5 years (sd 1.7) and 12% had a CD4+ T-cell count 200 copies/ml). Among children on nevirapine (NVP), plasma levels were subtherapeutic in 14.2% and supratherapeutic in 42.2%. Determinants of virological failure included male sex, lower CD4+ T-cell counts, subtherapeutic drug levels, longer time on ART and a deceased mother. Poor adherence was associated with subtherapeutic NVP plasma levels and advanced disease stages (WHO stage 3/4). Conclusions This study demonstrates high virological failure rates and a high variability of NVP plasma levels among HIV-infected children in a routine ART programme in rural Cameroon. Strategies to improve adherence to ART in HIV-infected children are urgently needed. |
| Databáze: | OpenAIRE |
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