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
by
Birkneh Tilahun Tadesse 1,2,*
, Adugna Chala 3, Jackson Mukonzo 4, Tolosssa Eticha Chaka 5, Sintayehu Tadesse 3, Eyasu Makonnen 3,6, Zabrina L. Brumme 7,8, Chanson J. Brumme 8,9 and Eleni Aklillu 1
Birkneh Tilahun Tadesse 1,2,*, Adugna Chala 3, Jackson Mukonzo 4, Tolosssa Eticha Chaka 5, Sintayehu Tadesse 3, Eyasu Makonnen 3,6, Zabrina L. Brumme 7,8, Chanson J. Brumme 8,9 and Eleni Aklillu 1
1
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
2
Department of Pediatrics, College of Medicine and Health Sciences, Hawassa University, Hawassa 1560, Ethiopia
3
Department of Pharmacology, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia
4
Department of Pharmacology, College of Health Sciences, Makerere University, Kampala, Uganda
5
Adama General Hospital and Medical College, Adama 84, Ethiopia
6
CDT Africa, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia
7
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
8
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
9
Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
*
Author to whom correspondence should be addressed.
Pathogens 2019, 8(4), 161; https://doi.org/10.3390/pathogens8040161
Received: 10 September 2019 / Revised: 19 September 2019 / Accepted: 20 September 2019 / Published: 24 September 2019
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.
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Keywords:
HIV; cART naïve; virologic outcome; pretreatment HIV drug resistance
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MDPI and ACS Style
Tadesse, B.T.; Chala, A.; Mukonzo, J.; Chaka, T.E.; Tadesse, S.; Makonnen, E.; Brumme, Z.L.; Brumme, C.J.; Aklillu, E. 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. Pathogens 2019, 8, 161.
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