Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana
Identifieur interne : 000611 ( Main/Exploration ); précédent : 000610; suivant : 000612Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana
Auteurs : Oliver Barry [États-Unis] ; Jonathan Powell [États-Unis] ; Lorna Renner [Ghana] ; Evelyn Y. Bonney [Ghana] ; Meghan Prin [États-Unis] ; William Ampofo [Ghana] ; Jonas Kusah [Ghana] ; Bamenla Goka [Ghana] ; Kwamena Wc Sagoe [Ghana] ; Veronika Shabanova [États-Unis] ; Elijah Paintsil [États-Unis]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2013.
Descripteurs français
- KwdFr :
- Adolescent, Agents antiVIH (usage thérapeutique), Charge virale (), Enfant, Enfant d'âge préscolaire, Femelle, Ghana, Humains, Infections à VIH (immunologie), Infections à VIH (traitement médicamenteux), Infections à VIH (virologie), Lymphocytes T CD4+ (), Lymphocytes T CD4+ (immunologie), Mâle, Nourrisson, Résistance virale aux médicaments, Résultat thérapeutique, VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (), VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (génétique), VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (physiologie), Études longitudinales, Études prospectives.
- MESH :
- génétique : VIH-1 (Virus de l'Immunodéficience Humaine de type 1).
- immunologie : Infections à VIH, Lymphocytes T CD4+.
- physiologie : VIH-1 (Virus de l'Immunodéficience Humaine de type 1).
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Agents antiVIH.
- virologie : Infections à VIH.
- Adolescent, Charge virale, Enfant, Enfant d'âge préscolaire, Femelle, Ghana, Humains, Lymphocytes T CD4+, Mâle, Nourrisson, Résistance virale aux médicaments, Résultat thérapeutique, VIH-1 (Virus de l'Immunodéficience Humaine de type 1), Études longitudinales, Études prospectives.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Adolescent, Anti-HIV Agents (therapeutic use), CD4-Positive T-Lymphocytes (drug effects), CD4-Positive T-Lymphocytes (immunology), Child, Child, Preschool, Drug Resistance, Viral, Female, Ghana, HIV Infections (drug therapy), HIV Infections (immunology), HIV Infections (virology), HIV-1 (drug effects), HIV-1 (genetics), HIV-1 (physiology), Humans, Infant, Longitudinal Studies, Male, Prospective Studies, Treatment Outcome, Viral Load (drug effects).
- MESH :
- chemical , therapeutic use : Anti-HIV Agents.
- geographic : Ghana.
- drug effects : CD4-Positive T-Lymphocytes, HIV-1, Viral Load.
- drug therapy : HIV Infections.
- genetics : HIV-1.
- immunology : CD4-Positive T-Lymphocytes, HIV Infections.
- physiology : HIV-1.
- virology : HIV Infections.
- Adolescent, Child, Child, Preschool, Drug Resistance, Viral, Female, Humans, Infant, Longitudinal Studies, Male, Prospective Studies, Treatment Outcome.
Abstract
Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load.
We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis.
Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with ≥ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child’s gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes.
First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries.
Url:
DOI: 10.1186/1471-2334-13-476
PubMed: 24119088
PubMed Central: 3852953
Affiliations:
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last="Barry">Oliver Barry</name><affiliation wicri:level="2"><nlm:aff id="I1">From the Columbia University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>From the Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</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="I2">Weill Cornell Medical College, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Weill Cornell Medical College, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></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="I3">University of Ghana Medical School, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana Medical School, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Bonney, Evelyn Y" sort="Bonney, Evelyn Y" uniqKey="Bonney E" first="Evelyn Y" last="Bonney">Evelyn Y. Bonney</name><affiliation wicri:level="4"><nlm:aff id="I4">Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Noguchi Memorial Institute of Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></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="I1">From the Columbia University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>From the Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Ampofo, William" sort="Ampofo, William" uniqKey="Ampofo W" first="William" last="Ampofo">William Ampofo</name><affiliation wicri:level="4"><nlm:aff id="I4">Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Noguchi Memorial Institute of Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></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="I3">University of Ghana Medical School, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana Medical School, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Goka, Bamenla" sort="Goka, Bamenla" uniqKey="Goka B" first="Bamenla" last="Goka">Bamenla Goka</name><affiliation wicri:level="3"><nlm:aff id="I3">University of Ghana Medical School, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana Medical School, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Sagoe, Kwamena Wc" sort="Sagoe, Kwamena Wc" uniqKey="Sagoe K" first="Kwamena Wc" last="Sagoe">Kwamena Wc Sagoe</name><affiliation wicri:level="3"><nlm:aff id="I3">University of Ghana Medical School, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana Medical School, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Shabanova, Veronika" sort="Shabanova, Veronika" uniqKey="Shabanova V" first="Veronika" last="Shabanova">Veronika Shabanova</name><affiliation wicri:level="2"><nlm:aff id="I5">Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, CT, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, CT</wicri:regionArea><placeName><region type="state">Connecticut</region></placeName></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="I6">Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, CT, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, CT</wicri:regionArea><placeName><region type="state">Connecticut</region></placeName></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Anti-HIV Agents (therapeutic use)</term><term>CD4-Positive T-Lymphocytes (drug effects)</term><term>CD4-Positive T-Lymphocytes (immunology)</term><term>Child</term><term>Child, Preschool</term><term>Drug Resistance, Viral</term><term>Female</term><term>Ghana</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (immunology)</term><term>HIV Infections (virology)</term><term>HIV-1 (drug effects)</term><term>HIV-1 (genetics)</term><term>HIV-1 (physiology)</term><term>Humans</term><term>Infant</term><term>Longitudinal Studies</term><term>Male</term><term>Prospective Studies</term><term>Treatment Outcome</term><term>Viral Load (drug effects)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Agents antiVIH (usage thérapeutique)</term><term>Charge virale ()</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Ghana</term><term>Humains</term><term>Infections à VIH (immunologie)</term><term>Infections à VIH (traitement médicamenteux)</term><term>Infections à VIH (virologie)</term><term>Lymphocytes T CD4+ ()</term><term>Lymphocytes T CD4+ (immunologie)</term><term>Mâle</term><term>Nourrisson</term><term>Résistance virale aux médicaments</term><term>Résultat thérapeutique</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1) ()</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (génétique)</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (physiologie)</term><term>Études longitudinales</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>CD4-Positive T-Lymphocytes</term><term>HIV-1</term><term>Viral Load</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="genetics" xml:lang="en"><term>HIV-1</term></keywords><keywords scheme="MESH" qualifier="génétique" xml:lang="fr"><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Infections à VIH</term><term>Lymphocytes T CD4+</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>CD4-Positive T-Lymphocytes</term><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="physiologie" xml:lang="fr"><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>HIV-1</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>Agents antiVIH</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Child</term><term>Child, Preschool</term><term>Drug Resistance, Viral</term><term>Female</term><term>Humans</term><term>Infant</term><term>Longitudinal Studies</term><term>Male</term><term>Prospective Studies</term><term>Treatment Outcome</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>Ghana</term><term>Humains</term><term>Lymphocytes T CD4+</term><term>Mâle</term><term>Nourrisson</term><term>Résistance virale aux médicaments</term><term>Résultat thérapeutique</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term><term>Études longitudinales</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load.</p></sec><sec><title>Methods</title><p>We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis.</p></sec><sec><title>Results</title><p>Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with ≥ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child’s gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes.</p></sec><sec><title>Conclusions</title><p>First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Paintsil, E" uniqKey="Paintsil E">E Paintsil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fassinou, P" uniqKey="Fassinou P">P Fassinou</name></author><author><name sortKey="Elenga, N" uniqKey="Elenga N">N Elenga</name></author><author><name sortKey="Rouet, F" uniqKey="Rouet F">F Rouet</name></author><author><name sortKey="Laguide, R" uniqKey="Laguide R">R Laguide</name></author><author><name sortKey="Kouakoussui, Ka" uniqKey="Kouakoussui K">KA Kouakoussui</name></author><author><name sortKey="Timite, M" uniqKey="Timite M">M Timite</name></author><author><name sortKey="Blanche, S" uniqKey="Blanche S">S Blanche</name></author><author><name sortKey="Msellati, P" 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Bakeera-Kitaka</name></author><author><name sortKey="Semitala, F" uniqKey="Semitala F">F Semitala</name></author><author><name sortKey="Mwebaze Songa, P" uniqKey="Mwebaze Songa P">P Mwebaze-Songa</name></author><author><name sortKey="Castelnuovo, B" uniqKey="Castelnuovo B">B Castelnuovo</name></author><author><name sortKey="Schaefer, P" uniqKey="Schaefer P">P Schaefer</name></author><author><name sortKey="Spacek, La" uniqKey="Spacek L">LA Spacek</name></author><author><name sortKey="Gasasira, Af" uniqKey="Gasasira A">AF Gasasira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nicastri, E" uniqKey="Nicastri E">E Nicastri</name></author><author><name sortKey="Angeletti, C" uniqKey="Angeletti C">C Angeletti</name></author><author><name sortKey="Palmisano, L" uniqKey="Palmisano L">L Palmisano</name></author><author><name sortKey="Sarmati, L" uniqKey="Sarmati L">L Sarmati</name></author><author><name sortKey="Chiesi, A" uniqKey="Chiesi A">A Chiesi</name></author><author><name sortKey="Geraci, A" uniqKey="Geraci A">A Geraci</name></author><author><name sortKey="Andreoni, M" uniqKey="Andreoni M">M Andreoni</name></author><author><name sortKey="Vella, S" uniqKey="Vella S">S Vella</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moore, Al" uniqKey="Moore A">AL Moore</name></author><author><name sortKey="Mocroft, A" uniqKey="Mocroft A">A Mocroft</name></author><author><name sortKey="Madge, S" uniqKey="Madge S">S Madge</name></author><author><name sortKey="Devereux, H" uniqKey="Devereux H">H Devereux</name></author><author><name sortKey="Wilson, D" uniqKey="Wilson D">D Wilson</name></author><author><name sortKey="Phillips, An" uniqKey="Phillips A">AN Phillips</name></author><author><name sortKey="Johnson, M" uniqKey="Johnson M">M Johnson</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>États-Unis</li></country><region><li>Connecticut</li><li>Région du Grand Accra</li><li>État de New York</li></region><settlement><li>Accra</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="Barry, Oliver" sort="Barry, Oliver" uniqKey="Barry O" first="Oliver" last="Barry">Oliver Barry</name></region><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><name sortKey="Shabanova, Veronika" sort="Shabanova, Veronika" uniqKey="Shabanova V" first="Veronika" last="Shabanova">Veronika Shabanova</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="Ampofo, William" sort="Ampofo, William" uniqKey="Ampofo W" first="William" last="Ampofo">William Ampofo</name><name sortKey="Bonney, Evelyn Y" sort="Bonney, Evelyn Y" uniqKey="Bonney E" first="Evelyn Y" last="Bonney">Evelyn Y. Bonney</name><name sortKey="Goka, Bamenla" sort="Goka, Bamenla" uniqKey="Goka B" first="Bamenla" last="Goka">Bamenla Goka</name><name sortKey="Kusah, Jonas" sort="Kusah, Jonas" uniqKey="Kusah J" first="Jonas" last="Kusah">Jonas Kusah</name><name sortKey="Sagoe, Kwamena Wc" sort="Sagoe, Kwamena Wc" uniqKey="Sagoe K" first="Kwamena Wc" last="Sagoe">Kwamena Wc Sagoe</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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