Abstract:
Background: Antiretroviral therapy (ART) in resource-limited settings is
effective when backed up with adequate clinical, immunological, and virologic
monitoring. Undetected, virologic failure results in increased HIV-1 drug
resistance mutations (DRMs), morbidity and mortality, or the need for costly
second-line and third-line ART.
Objective: To evaluate the prevalence, patterns, and risk factors of virologic
failure and slow response to ART, among children and adolescents in
resource-limited settings in Nairobi, Kenya.
Design: A Retrospective study.
Setting: The 8 Lea Toto Programme (LTP) Clinics in Dagoretti, Dandora,
Kangemi, Kariobangi, Kawangware, Kibera, Mukuru, and Zimmerman areas
of Nairobi. Subjects: One hundred and forty-six HIV-infected children and
adolescents aged 1 month to 19 years of the LTP in Nairobi Kenya. Medical
and demographic data including, HIV-1 viral loads, information on adherence
to ART, HIV-1 DRMs and other key determinants of virologic failure, collected
over a period of 2 years, was used for this study.
488 EAST AFRICAN MEDICAL JOURNAL July 2017
Results: A threshold of 1,000 HIV RNA copies/ml was used to determine
treatment outcome. The virologic failure rates in this cohort were 43.8% after 6
months, 32.2% after 12 months, 28.8% after 18 months, and 24.0% after 24
months of first-line ART. Twelve (8.2%) of 146 children showed a slow
response to ART: they initially failed ART at 12 months, but had treatment
success after 18 to 24 months. The rates of virologic rebound were 4 (2.7%) after
18 months and 3 (2.1%) after 24 months of ART. Multivariate Cox proportional
hazards regression revealed that children with suboptimal adherence to ART
were 37 times more likely to experience virologic failure (P = 0.000003).
Conclusions: This study showed that ART implementation in resource-limited
settings is effective when regular virologic monitoring, adherence counselling,
and HIV-DR testing are available. Secondly, adherence to ART is a strong
predictor of treatment outcome for children and adolescents in resourcelimited settings. Therefore, methods of optimizing adherence levels should be
explored and implemented.
