Long-Term Virologic Outcome in Children Receiving ART

Monitoring of viral load at least every 6 months after initiation of antiretroviral therapy (ART) in children with HIV allows early identification of virologic failure and subsequent regimen change to avoid accumulation of resistant strains and treatment failures, according to a study published in AIDS Research and Therapy.¹

Although ART coverage in HIV-infected children has increased in many countries, resulting in a decrease in morbidity and mortality from HIV infection,² treatment failure in this population is an increasing concern. ART monitoring has proven difficult in low- and middle-income countries because of inadequate laboratory facilities, a shortage of trained staff, and the prohibitive cost of expensive reagents. Therefore, researchers in India evaluated the long-term outcome of 393 children receiving initial first-line ART and assessed the factors associated with virologic suppression or virologic failure after 12 months of ART.¹

They found that at 48 weeks, significant improvement occurred in weight- and height-for-age z-scores from baseline (all P <0.001). Nearly 90% of children had an increase in their absolute CD4+ T cell count to >350 cells/mm³, although immunologic failure was noted among 11% (28/261) of children. Virologic failure was noted in 29% (94/328) of children at 12 months; however, 36 of these children showed immunologic failure while the rest had good immunologic improvement.

There did not appear to be a correlation between virologic and immunologic failure and there were no statistically significant predictors to detect who would have virologic failure on treatment. More than 90% adherence with ART was reported for 62% of the children. Multiple nonnucleoside reverse transcription inhibitor-associated mutations were observed at the time of virologic failure.

The authors concluded that, “plasma HIV-1 RNA detection along with adherence counseling should be done periodically as a priority, to ensure proper monitoring of children receiving ART.”¹

References

1. Chandrasekaran P, Shet A, Srinivasan R, et al. Long‑term virological outcome in children receiving first‑line antiretroviral therapy. AIDS Res Ther. 2018;15(1):23.
2. Koye DN, Ayele TA, Zeleke BM. Predictors of mortality among children on antiretroviral therapy at a referral hospital, Northwest Ethiopia: a retrospective follow up study. BMC Pediatr. 2012;12:161.