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. 2015 Dec 14;10(12):e0144057.
doi: 10.1371/journal.pone.0144057. eCollection 2015.

Clinical, Virologic, Immunologic Outcomes and Emerging HIV Drug Resistance Patterns in Children and Adolescents in Public ART Care in Zimbabwe

A T Makadzange  1   2 , M Higgins-Biddle  3 , B Chimukangara  2   4 , R Birri  2 , M Gordon  5 , T Mahlanza  2 , G McHugh  2 , J H van Dijk  2 , M Bwakura-Dangarembizi  6 , T Ndung'u  5 , C Masimirembwa  4 , B Phelps  7 , A Amzel  7 , B O Ojikutu  3 , B D Walker  1 , C E Ndhlovu  2
Affiliations

Clinical, Virologic, Immunologic Outcomes and Emerging HIV Drug Resistance Patterns in Children and Adolescents in Public ART Care in Zimbabwe

A T Makadzange et al. PLoS One. .

Abstract

Objective: To determine immunologic, virologic outcomes and drug resistance among children and adolescents receiving care during routine programmatic implementation in a low-income country.

Methods: A cross-sectional evaluation with collection of clinical and laboratory data for children (0-<10 years) and adolescents (10-19 years) attending a public ART program in Harare providing care for pediatric patients since 2004, was conducted. Longitudinal data for each participant was obtained from the clinic based medical record.

Results: Data from 599 children and adolescents was evaluated. The participants presented to care with low CD4 cell count and CD4%, median baseline CD4% was lower in adolescents compared with children (11.0% vs. 15.0%, p<0.0001). The median age at ART initiation was 8.0 years (IQR 3.0, 12.0); median time on ART was 2.9 years (IQR 1.7, 4.5). On ART, median CD4% improved for all age groups but remained below 25%. Older age (≥ 5 years) at ART initiation was associated with severe stunting (HAZ <-2: 53.3% vs. 28.4%, p<0.0001). Virologic failure rate was 30.6% and associated with age at ART initiation. In children, nevirapine based ART regimen was associated with a 3-fold increased risk of failure (AOR: 3.5; 95% CI: 1.3, 9.1, p = 0.0180). Children (<10 y) on ART for ≥4 years had higher failure rates than those on ART for <4 years (39.6% vs. 23.9%, p = 0.0239). In those initiating ART as adolescents, each additional year in age above 10 years at the time of ART initiation (AOR 0.4 95%CI: 0.1, 0.9, p = 0.0324), and each additional year on ART (AOR 0.4, 95%CI 0.2, 0.9, p = 0.0379) were associated with decreased risk of virologic failure. Drug resistance was evident in 67.6% of sequenced virus isolates.

Conclusions: During routine programmatic implementation of HIV care for children and adolescents, delayed age at ART initiation has long-term implications on immunologic recovery, growth and virologic outcomes.

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Conflict of interest statement

Competing Interests: The authors have the following interests: Authors Molly Higgins-Biddle and Bisola Ojikutu are employees of John Snow Inc. A. Tariro Makadzange has served as a consultant on the grant. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. CD4 recovery on ART by age at ART initiation (n = 387).
Fig 2
Fig 2. Virologic failure (a) by age group at cross-sectional evaluation (n = 599), (b) Virologic failure by age at ART initiation (n = 599).
See this image and copyright information in PMC

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References

    1. WHO (2013) Global update on HIV treatment 2013: results, impact and opportunities: World Health Organization report in partnership with UNICEF and UNAIDS. http://www.who.int/hiv/pub/progressreports/update2013/en/.
    1. WHO (2013) Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV infection. Recommendations for a public health approach. http://wwwwhoint/hiv/pub/guidelines/arv2013/download/en/. - PubMed
    1. WHO (2015) Guideline on when to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/: WHO. - PubMed
    1. Hazra R, Siberry GK, Mofenson LM (2010) Growing up with HIV: children, adolescents, and young adults with perinatally acquired HIV infection. Annu Rev Med 61: 169–185. 10.1146/annurev.med.050108.151127 - DOI - PubMed
    1. Sutcliffe CG, van Dijk JH, Bolton C, Persaud D, Moss WJ (2008) Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. Lancet Infect Dis 8: 477–489. 10.1016/S1473-3099(08)70180-4 - DOI - PubMed

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