Virologic response of treatment experienced HIV-infected Ugandan children and adolescents on NNRTI based first-line regimen, previously monitored without viral load

作者：Phionah Kibalama Ssemambo, Mary Gorrethy Nalubega-Mboowa, Arthur H. Owora, Robert Serunjogi, Susan Kironde, Sarah Nakabuye, Francis Ssozi, Maria Nannyonga, Philippa Musoke, Linda Barlow‐Mosha · 发表于：BMC Pediatrics · 年份：2021 · DOI：10.1186/s12887-021-02608-0 · 被引用次数：4 · 研究领域：HIV/AIDS Research and Interventions、HIV/AIDS drug development and treatment、HIV Research and Treatment

BACKGROUND: Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansion of PEPFAR programs since 2004 and introduction of "Test and Treat" WHO guidelines in 2015. As ART access increases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL) monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there's limited data on the comparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS). METHODS: HIV-infected Ugandan children aged 1-12 years from HIV-care programs with > 1 year of first-line ART using only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligible children were stratified by VL ≤ 400 and > 400 copies/ml randomized to clinical and immunological (control) versus clinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48 weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used to compare the prevalence of viral suppression between study arms and identify factors associated with viral suppression. RESULTS: At baseline all children (n = 142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third of ART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartile range [IQR]: 5-9) and 43% were female....