Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana
Identifieur interne : 000115 ( Main/Exploration ); précédent : 000114; suivant : 000116Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana
Auteurs : Omobolawa Kukoyi [États-Unis] ; Lorna Renner [Ghana] ; Jonathan Powell [États-Unis] ; Oliver Barry [États-Unis] ; Meghan Prin [États-Unis] ; Jonas Kusah [Ghana] ; Xiangyu Cong [États-Unis] ; Elijah Paintsil [États-Unis]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2016.
Descripteurs français
- KwdFr :
- Adolescent, Antirétroviraux (usage thérapeutique), Charge virale (), Enfant, Enfant d'âge préscolaire, Femelle, Ghana (épidémiologie), Hospitalisation, Humains, Infections opportunistes, Infections à VIH (traitement médicamenteux), Infections à VIH (épidémiologie), Morbidité, Mâle, Pédiatrie, Résultat thérapeutique, Virémie, Études longitudinales, Études prospectives.
- MESH :
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Antirétroviraux.
- épidémiologie : Ghana, Infections à VIH.
- Adolescent, Charge virale, Enfant, Enfant d'âge préscolaire, Femelle, Hospitalisation, Humains, Infections opportunistes, Morbidité, Mâle, Pédiatrie, Résultat thérapeutique, Virémie, Études longitudinales, Études prospectives.
English descriptors
- KwdEn :
- Adolescent, Anti-Retroviral Agents (therapeutic use), Child, Child, Preschool, Female, Ghana (epidemiology), HIV Infections (drug therapy), HIV Infections (epidemiology), Hospitalization, Humans, Longitudinal Studies, Male, Morbidity, Opportunistic Infections, Pediatrics, Prospective Studies, Treatment Outcome, Viral Load (drug effects), Viremia.
- MESH :
- chemical , therapeutic use : Anti-Retroviral Agents.
- drug effects : Viral Load.
- drug therapy : HIV Infections.
- epidemiology : Ghana, HIV Infections.
- Adolescent, Child, Child, Preschool, Female, Hospitalization, Humans, Longitudinal Studies, Male, Morbidity, Opportunistic Infections, Pediatrics, Prospective Studies, Treatment Outcome, Viremia.
Abstract
HIV-infected children in sub-Saharan Africa may be at a high risk of staying on a failing first-line regimen and developing drug-resistance HIV variants due to lack of routine viral load monitoring. We investigated whether cumulative viral load, measured as viremia copy-years (VCY) could predict morbidity in a setting where viral load is not routinely monitored.
This was a single-center prospective observational longitudinal study of HIV-infected children initiating antiretroviral therapy (ART) at the Pediatric HIV/AIDS Care program at Korle-Bu Teaching Hospital in Accra, Ghana. The main outcome was morbidity measured as frequency of hospitalizations, opportunistic infections, and outpatient sick visits. The main explanatory variable was viral load measured as VCY.
The study included 140 children who initiated ART between September 2009 and May 2013 and had at least 2 viral load measurements. There were 184 hospitalizations, with pneumonia being the most common cause (22.8 %). A total of 102 opportunistic infections was documented, with tuberculosis being the most common opportunistic infection (68 %). A total of 823 outpatient sick visits was documented, with upper respiratory infections (14.2 %) being the most common cause. Forty-four percent of our study participants had >4 log10 VCY. Children in this sub-cohort had a higher frequency of sick visits compared with those with <4 log10 VCY (
High level of cumulative viral load may translate to virological failure and subsequent increased all-cause morbidity. Our finding of potential utility of VCY in pediatrics warrants further investigations. VCY may be a good alternate to routine viral load measurement as its determination may be less frequent and could be personalized to save cost.
Url:
DOI: 10.1186/s12879-016-1402-9
PubMed: 26843068
PubMed Central: 4738803
Affiliations:
- Ghana, États-Unis
- Caroline du Nord, Connecticut, Massachusetts, Région du Grand Accra, État de New York
- Accra
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Le document en format XML
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id="Aff1">From Duke University School of Medicine, Durham, NC USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Caroline du Nord</region></placeName><wicri:cityArea>From Duke University School of Medicine, Durham</wicri:cityArea></affiliation></author><author><name sortKey="Renner, Lorna" sort="Renner, Lorna" uniqKey="Renner L" first="Lorna" last="Renner">Lorna Renner</name><affiliation wicri:level="3"><nlm:aff id="Aff2">University of Ghana School of Medicine and Dentistry, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana School of Medicine and Dentistry, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Powell, Jonathan" sort="Powell, Jonathan" uniqKey="Powell J" first="Jonathan" last="Powell">Jonathan Powell</name><affiliation wicri:level="2"><nlm:aff id="Aff3">Weill Cornell Medical College, New York, NY USA</nlm:aff><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Weill Cornell Medical College, New York</wicri:cityArea></affiliation></author><author><name sortKey="Barry, Oliver" sort="Barry, Oliver" uniqKey="Barry O" first="Oliver" last="Barry">Oliver Barry</name><affiliation wicri:level="2"><nlm:aff id="Aff4">Boston Children’s Hospital, Harvard Medical School, Boston, MA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName><wicri:cityArea>Boston Children’s Hospital, Harvard Medical School, Boston</wicri:cityArea></affiliation></author><author><name sortKey="Prin, Meghan" sort="Prin, Meghan" uniqKey="Prin M" first="Meghan" last="Prin">Meghan Prin</name><affiliation wicri:level="2"><nlm:aff id="Aff5">Columbia University, New York, NY USA</nlm:aff><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="Kusah, Jonas" sort="Kusah, Jonas" uniqKey="Kusah J" first="Jonas" last="Kusah">Jonas Kusah</name><affiliation wicri:level="3"><nlm:aff id="Aff2">University of Ghana School of Medicine and Dentistry, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana School of Medicine and Dentistry, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Cong, Xiangyu" sort="Cong, Xiangyu" uniqKey="Cong X" first="Xiangyu" last="Cong">Xiangyu Cong</name><affiliation wicri:level="2"><nlm:aff id="Aff6">Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, CT USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Connecticut</region></placeName><wicri:cityArea>Yale Center for Analytical Sciences, Yale School of Medicine, New Haven</wicri:cityArea></affiliation></author><author><name sortKey="Paintsil, Elijah" sort="Paintsil, Elijah" uniqKey="Paintsil E" first="Elijah" last="Paintsil">Elijah Paintsil</name><affiliation wicri:level="2"><nlm:aff id="Aff7">Departments of Pediatrics, Pharmacology & Public Health, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT 06520 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Connecticut</region></placeName><wicri:cityArea>Departments of Pediatrics, Pharmacology & Public Health, Yale University School of Medicine, 464 Congress Avenue, New Haven</wicri:cityArea></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Anti-Retroviral Agents (therapeutic use)</term><term>Child</term><term>Child, Preschool</term><term>Female</term><term>Ghana (epidemiology)</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (epidemiology)</term><term>Hospitalization</term><term>Humans</term><term>Longitudinal Studies</term><term>Male</term><term>Morbidity</term><term>Opportunistic Infections</term><term>Pediatrics</term><term>Prospective Studies</term><term>Treatment Outcome</term><term>Viral Load (drug effects)</term><term>Viremia</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Antirétroviraux (usage thérapeutique)</term><term>Charge virale ()</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Ghana (épidémiologie)</term><term>Hospitalisation</term><term>Humains</term><term>Infections opportunistes</term><term>Infections à VIH (traitement médicamenteux)</term><term>Infections à VIH (épidémiologie)</term><term>Morbidité</term><term>Mâle</term><term>Pédiatrie</term><term>Résultat thérapeutique</term><term>Virémie</term><term>Études longitudinales</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Viral Load</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Ghana</term><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antirétroviraux</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Ghana</term><term>Infections à VIH</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Child</term><term>Child, Preschool</term><term>Female</term><term>Hospitalization</term><term>Humans</term><term>Longitudinal Studies</term><term>Male</term><term>Morbidity</term><term>Opportunistic Infections</term><term>Pediatrics</term><term>Prospective Studies</term><term>Treatment Outcome</term><term>Viremia</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Charge virale</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Hospitalisation</term><term>Humains</term><term>Infections opportunistes</term><term>Morbidité</term><term>Mâle</term><term>Pédiatrie</term><term>Résultat thérapeutique</term><term>Virémie</term><term>Études longitudinales</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">HIV-infected children in sub-Saharan Africa may be at a high risk of staying on a failing first-line regimen and developing drug-resistance HIV variants due to lack of routine viral load monitoring. We investigated whether cumulative viral load, measured as viremia copy-years (VCY) could predict morbidity in a setting where viral load is not routinely monitored.</p></sec><sec><title>Methods</title><p id="Par2">This was a single-center prospective observational longitudinal study of HIV-infected children initiating antiretroviral therapy (ART) at the Pediatric HIV/AIDS Care program at Korle-Bu Teaching Hospital in Accra, Ghana. The main outcome was morbidity measured as frequency of hospitalizations, opportunistic infections, and outpatient sick visits. The main explanatory variable was viral load measured as VCY.</p></sec><sec><title>Results</title><p id="Par3">The study included 140 children who initiated ART between September 2009 and May 2013 and had at least 2 viral load measurements. There were 184 hospitalizations, with pneumonia being the most common cause (22.8 %). A total of 102 opportunistic infections was documented, with tuberculosis being the most common opportunistic infection (68 %). A total of 823 outpatient sick visits was documented, with upper respiratory infections (14.2 %) being the most common cause. Forty-four percent of our study participants had >4 log<sub>10</sub> VCY. Children in this sub-cohort had a higher frequency of sick visits compared with those with <4 log<sub>10</sub> VCY (<italic>p</italic> = 0.03). Only 6.5 % of children with >4 log<sub>10</sub> VCY had been identified as treatment failure using WHO clinical and immunological treatment failure criteria.</p></sec><sec><title>Conclusions</title><p id="Par4">High level of cumulative viral load may translate to virological failure and subsequent increased all-cause morbidity. Our finding of potential utility of VCY in pediatrics warrants further investigations. VCY may be a good alternate to routine viral load measurement as its determination may be less frequent and could be personalized to save cost.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mellors, Jw" uniqKey="Mellors J">JW Mellors</name></author><author><name sortKey="Munoz, A" uniqKey="Munoz A">A Munoz</name></author><author><name sortKey="Giorgi, Jv" uniqKey="Giorgi J">JV Giorgi</name></author><author><name sortKey="Margolick, Jb" uniqKey="Margolick J">JB Margolick</name></author><author><name sortKey="Tassoni, Cj" uniqKey="Tassoni C">CJ Tassoni</name></author><author><name sortKey="Gupta, P" uniqKey="Gupta P">P Gupta</name></author><author><name sortKey="Kingsley, La" uniqKey="Kingsley L">LA Kingsley</name></author><author><name sortKey="Todd, Ja" uniqKey="Todd J">JA Todd</name></author><author><name sortKey="Saah, Aj" uniqKey="Saah A">AJ 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Hoffmann</name></author><author><name sortKey="Van Lunzen, J" uniqKey="Van Lunzen J">J van Lunzen</name></author><author><name sortKey="Hamouda, O" uniqKey="Hamouda O">O Hamouda</name></author><author><name sortKey="Clinsurv Study, G" uniqKey="Clinsurv Study G">G ClinSurv Study</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Orrell, C" uniqKey="Orrell C">C Orrell</name></author><author><name sortKey="Harling, G" uniqKey="Harling G">G Harling</name></author><author><name sortKey="Lawn, Sd" uniqKey="Lawn S">SD Lawn</name></author><author><name sortKey="Kaplan, R" uniqKey="Kaplan R">R Kaplan</name></author><author><name sortKey="Mcnally, M" uniqKey="Mcnally M">M McNally</name></author><author><name sortKey="Bekker, Lg" uniqKey="Bekker L">LG Bekker</name></author><author><name sortKey="Wood, R" uniqKey="Wood R">R Wood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Belec, L" uniqKey="Belec L">L Belec</name></author><author><name sortKey="Bonn, Jp" uniqKey="Bonn J">JP Bonn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roberts, T" uniqKey="Roberts T">T Roberts</name></author><author><name sortKey="Bygrave, H" uniqKey="Bygrave H">H Bygrave</name></author><author><name sortKey="Fajardo, E" uniqKey="Fajardo E">E Fajardo</name></author><author><name sortKey="Ford, N" uniqKey="Ford N">N Ford</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>États-Unis</li></country><region><li>Caroline du Nord</li><li>Connecticut</li><li>Massachusetts</li><li>Région du Grand Accra</li><li>État de New York</li></region><settlement><li>Accra</li></settlement></list><tree><country name="États-Unis"><region name="Caroline du Nord"><name sortKey="Kukoyi, Omobolawa" sort="Kukoyi, Omobolawa" uniqKey="Kukoyi O" first="Omobolawa" last="Kukoyi">Omobolawa Kukoyi</name></region><name sortKey="Barry, Oliver" sort="Barry, Oliver" uniqKey="Barry O" first="Oliver" last="Barry">Oliver Barry</name><name sortKey="Cong, Xiangyu" sort="Cong, Xiangyu" uniqKey="Cong X" first="Xiangyu" last="Cong">Xiangyu Cong</name><name sortKey="Paintsil, Elijah" sort="Paintsil, Elijah" uniqKey="Paintsil E" first="Elijah" last="Paintsil">Elijah Paintsil</name><name sortKey="Powell, Jonathan" sort="Powell, Jonathan" uniqKey="Powell J" first="Jonathan" last="Powell">Jonathan Powell</name><name sortKey="Prin, Meghan" sort="Prin, Meghan" uniqKey="Prin M" first="Meghan" last="Prin">Meghan Prin</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Renner, Lorna" sort="Renner, Lorna" uniqKey="Renner L" first="Lorna" last="Renner">Lorna Renner</name></region><name sortKey="Kusah, Jonas" sort="Kusah, Jonas" uniqKey="Kusah J" first="Jonas" last="Kusah">Jonas Kusah</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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