First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria
Journal Title: Journal of HIV for Clinical and Scientific Research - Year 2015, Vol 2, Issue 2
Abstract
Background: In high-income countries, viral load is routinely used for monitoring HIV patients on antiretroviral therapy for early detection of drug failure. This is not the case in most resource limited settings like ours where only WHO immunological and clinical criteria are used for monitoring. This study is aimed at determining the rate/time of failure to 1st and 2nd antiretroviral drugs in children in our centers. Method: Is a retrospective study of children ≤18 years switched to 2nd line antiretroviral regimen and those requiring third line drugs from Jan 2006 to June 2015 in our health institution. Data analysis was conducted using SPSS version 16.0 software and statistical significance set at p < 0.05. Result: Sixteen percent (82/514) of children on 1st line medication were switched to 2nd line drugs with switch over rate of 9 persons/year, and 6/82 (7.3%) required 3rd line medication. The median switch over time was 31.3 months (IQR 26.4-36.2) for 2nd line medication, and 42.6 months (IQR 40.1-44.3) from time of switch to 2nd line drugs for those requiring 3rd line regimen. Over 90% of patients switched to 2nd line drugs were between 9-18 years, none was an infant. The mean CD4 cell count and viral load before switch to 2nd line drugs were 109.09±29.23 cell/mm3 and 180,480.29±35,303 copies/ml, and 89.42±28.67 cell/mm3/ 237,337.5±64,619 copies/ml for those requiring 3rd line medications. There was over 450 fold increase in viral load from the expected undetectable level of 400 copies/ml after 6 months on medication before patients were switch to 2nd line drugs, and over 590 folds increase for those that require 3rd line medications. Significant difference was seen in the mean CD4 cell count and weight of those with adherence of ≥ 95% and ≤ 95% (p values were <0.05). Conclusion: WHO immunological and clinical criteria were found not to be ideal for monitoring of children on antiretroviral therapy. Six monthly viral load monitoring and resistance testing should be introduced in Nigerian guideline for managing HIV children for better therapeutic and pharmaco-economic outcomes. Third line medication should also be made available in the country and intensification of adherence is required in adolescent age group.
Authors and Affiliations
Okechukwu Adaora A, Amajuoyi Frank I
Keywords
Related Articles
- EP ID EP348004
- DOI 10.17352/2455-3786.000014
- Views 107
- Downloads 0
Assessment of Level of Knowledge and Practice of Nursing and Midwifery Students on HIV Post Exposure Prophylaxis in Hawassa University, Ethiopia
Background: Nurses, midwives and other health care workers are at risk from Human Immunodeficiency Virus (HIV) and other blood borne infections in the workplace. Post exposure prophylaxis of HIV is the only way to reduce...
Pseudomembranous Candidiasis Indicates High Level Drug Resistance among Patients on Antiretroviral Treatment in Nairobi East District, Kenya
Objectives: The aim of this study was to determine antiretroviral drug resistance patterns in patients on long-term antiretroviral therapy presenting with OPC. Methods: An exploratory survey was performed among HIV-infec...
Care burden derived from the introduction of an early Lung Cancer Screening Program in high risk HIV-infected patients
We describe the care burden derived of a lung cancer screening program in HIV high risk patients. In a well selected group with the described criteria, one annual low-dose thoracic computed tomographic exploration can be...
Nutritional outcomes in HIV-Exposed Infants in the Mingha Program, Dschang-Cameroon (2003-2011)
Background: Prevention of Mother to Child Transmission (PMTCT) is a set of interventions that contribute in reducing the risk of HIV transmission from mother (parents) to the child. The infant feeding choice in the HIV c...
Occupational Acquisition of HIV Infection by Healthcare Workers in the United States
Healthcare Is the fastest growing sector (5.6% increase in 2016) of the United States economy, comprising 17.8% ($3,2 trillion) of the gross domestic product. There are more than 18,000,000 American healthcare profession...