Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana
Identifieur interne : 000086 ( Pmc/Curation ); précédent : 000085; suivant : 000087Viral 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.
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.
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DOI: 10.1186/s12879-016-1402-9
PubMed: 26843068
PubMed Central: 4738803
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana</title><author><name sortKey="Kukoyi, Omobolawa" sort="Kukoyi, Omobolawa" uniqKey="Kukoyi O" first="Omobolawa" last="Kukoyi">Omobolawa Kukoyi</name><affiliation wicri:level="2"><nlm:aff 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="1"><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></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="1"><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></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 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type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738803</idno><idno type="RBID">PMC:4738803</idno><idno type="doi">10.1186/s12879-016-1402-9</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000087</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000087</idno><idno type="wicri:Area/Pmc/Curation">000086</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000086</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana</title><author><name sortKey="Kukoyi, Omobolawa" sort="Kukoyi, Omobolawa" uniqKey="Kukoyi O" first="Omobolawa" last="Kukoyi">Omobolawa Kukoyi</name><affiliation wicri:level="2"><nlm:aff 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="1"><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></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="1"><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></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></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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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id><journal-title-group><journal-title>BMC Infectious Diseases</journal-title></journal-title-group><issn pub-type="epub">1471-2334</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26843068</article-id><article-id pub-id-type="pmc">4738803</article-id><article-id pub-id-type="publisher-id">1402</article-id><article-id pub-id-type="doi">10.1186/s12879-016-1402-9</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kukoyi</surname><given-names>Omobolawa</given-names></name><address><email>mkukoyi1@gmail.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Renner</surname><given-names>Lorna</given-names></name><address><email>lorna.renner@gmail.com</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Powell</surname><given-names>Jonathan</given-names></name><address><email>powell.jonathan@gmail.com</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Barry</surname><given-names>Oliver</given-names></name><address><email>oliver.m.barry@gmail.com</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Prin</surname><given-names>Meghan</given-names></name><address><email>Meghan.prin@gmail.com</email></address><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Kusah</surname><given-names>Jonas</given-names></name><address><email>jonaskusah@yahoo.co.uk</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Cong</surname><given-names>Xiangyu</given-names></name><address><email>tcgggg@gmail.com</email></address><xref ref-type="aff" rid="Aff6">6</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Paintsil</surname><given-names>Elijah</given-names></name><address><phone>203-785-6101</phone><email>elijah.paintsil@yale.edu</email></address><xref ref-type="aff" rid="Aff7">7</xref></contrib><aff id="Aff1"><label>1</label>From Duke University School of Medicine, Durham, NC USA</aff><aff id="Aff2"><label>2</label>University of Ghana School of Medicine and Dentistry, Accra, Ghana</aff><aff id="Aff3"><label>3</label>Weill Cornell Medical College, New York, NY USA</aff><aff id="Aff4"><label>4</label>Boston Children’s Hospital, Harvard Medical School, Boston, MA USA</aff><aff id="Aff5"><label>5</label>Columbia University, New York, NY USA</aff><aff id="Aff6"><label>6</label>Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, CT USA</aff><aff id="Aff7"><label>7</label>Departments of Pediatrics, Pharmacology & Public Health, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT 06520 USA</aff></contrib-group><pub-date pub-type="epub"><day>3</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>3</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>16</volume><elocation-id>58</elocation-id><history><date date-type="received"><day>4</day><month>11</month><year>2015</year></date><date date-type="accepted"><day>28</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>© Kukoyi et al. 2016</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><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></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Pediatric HIV</kwd><kwd>Cumulative viral load</kwd><kwd>viral copy years</kwd><kwd>Morbidity</kwd><kwd>Resource-limited setting</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000071</institution-id><institution>National Institute of Child Health and Human Development</institution></institution-wrap></funding-source><award-id>R01HD074253</award-id><principal-award-recipient><name><surname>Paintsil</surname><given-names>Elijah</given-names></name></principal-award-recipient></award-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000862</institution-id><institution>Doris Duke Charitable Foundation</institution></institution-wrap></funding-source></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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