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FIRST- LINE ANTIRETROVIRAL TREATMENT FAILURE IN EAST AFRICAN CHILDREN
Irene Marete1, Ann Mwangi2, Steven Brown3
1Department of Pediatrics and Child Health, Moi University School of Medicine, P.O. Box 4606-30100 Kenya.
East African Medical Journal
|May 2, 2022
Summary
Antiretroviral treatment failure is common in East African children with HIV, with clinical failure rates reaching 31% by four years. Factors like advanced disease at treatment start and rural residence contribute to failure, highlighting the need for improved management strategies.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Epidemiology
- Clinical Trial Analysis
Background:
- Antiretroviral therapy (ART) is crucial for managing HIV in children.
- Treatment failure remains a significant challenge in pediatric HIV care, particularly in resource-limited settings.
- Understanding incidence and predictors of failure is vital for optimizing pediatric ART programs.
Purpose of the Study:
- To determine the incidence of antiretroviral treatment failure in a pediatric cohort in East Africa.
- To identify factors associated with clinical and immunological treatment failure in children with HIV.
- To assess the rate of switching to second-line ART for children experiencing treatment failure.
Main Methods:
- Retrospective cohort study utilizing electronic medical records from the East African International epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium.
- Defined clinical failure as WHO stage or CDC class advancement ≥24 weeks post-ART initiation.
- Defined immunological failure based on age-specific CD4 count thresholds ≥24 weeks post-ART initiation.
Main Results:
- Cumulative incidence of clinical ART failure reached 31% at four years; immunological failure reached 22.5% at four years.
- Factors associated with clinical failure included advanced WHO stage/CDC class at ART initiation, year ART started, and rural residence.
- Male gender and younger age at ART initiation were associated with immunological failure. Only 6% of children with clinical failure switched to second-line ART within four years.
Conclusions:
- The incidence of clinical and immunological ART failure is substantial and increases over time in East African children.
- Identifying high-risk patients and improving ART management, including timely switching to second-line therapy, is critical.
- Further research is needed to address barriers to effective ART management and treatment failure in this population.
