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Published on: October 31, 2010
Brief Report: Group-Based Trajectory Modeling to Determine Long-Term HIV Viral Load Trends Among Children With HIV in
Jillian Neary1, Irene Njuguna2,3, Anjuli D Wagner2
1Department of Epidemiology, University of Washington, Seattle, WA.
Insights
Group-based trajectory modeling identified distinct HIV viral load patterns in children. Younger caregivers and specific antiretroviral regimens were linked to higher viral loads, highlighting needs for adherence support and palatable treatments.
Area of Science:
- Pediatric infectious diseases
- HIV/AIDS clinical research
- Viral load dynamics
Background:
- Understanding longitudinal HIV viral load (VL) trajectories in children is crucial for optimizing clinical strategies.
- Identifying factors associated with nonadherence is key to improving treatment outcomes.
- Group-based trajectory modeling (GBTM) offers a method to analyze complex VL patterns over time.
Purpose of the Study:
- To identify determinants of longitudinal HIV viral load (VL) trajectories in children.
- To inform clinical strategies and understand mechanisms of nonadherence.
- To define distinct VL patterns and their correlates in pediatric HIV patients.
Main Methods:
- Utilized group-based trajectory modeling (GBTM) on data from the Optimizing Pediatric HIV therapy cohort (NCT00428116).
- Assessed viral load (VL) every 3-6 months for up to 8 years in children newly diagnosed with HIV under 12 months old.
- Employed Fisher's exact and Kruskal-Wallis tests to compare correlates of different VL trajectory groups.
Main Results:
- Five VL trajectory groups were identified between 6-24 months, including sustained-low (63%) and sustained-high (9%).
- Children in sustained-high VL groups were more likely on protease inhibitor (PI)-based regimens and had younger caregivers.
- From 48-96 months, five groups emerged, with high-to-low VL trajectories associated with younger caregivers.
Conclusions:
- GBTM revealed unique viral load patterns in children with unsuppressed HIV viral load.
- Caregiver age and antiretroviral regimen characteristics correlated with viral load patterns.
- Targeted counseling for younger caregivers and development of palatable pediatric HIV regimens are recommended.
Background:
Identifying determinants of longitudinal HIV viral load (VL) trajectories using group-based trajectory modeling (GBTM) can inform clinical strategies and mechanisms of nonadherence among children.
Methods:
Children under 12 months old who were newly diagnosed with HIV were enrolled in the Optimizing Pediatric HIV therapy cohort (NCT00428116) from 2007 to 2010. Children initiated antiretroviral therapy at enrollment, and VL was assessed every 3 months for 24 months post-antiretroviral therapy and every 6 months thereafter up to 8 years old. VL trajectory groups were defined using GBTM. Fisher's exact and Kruskal-Wallis tests were used to determine the correlates of each trajectory group compared with the sustained-low VL group.
Results:
Five VL trajectory groups were identified among 89 children with 522 VL visits from 6 to 24 months: sustained-low (63% of children), sustained-very-high (16%), sustained-high (9%), low-to-high (7%), and high-with-periods-of-low (6%). Children in the sustained-high group were more frequently on a first-line protease inhibitor (PI)-based regimen (63% vs 38%; P = 0.03) and had younger caregivers (median: 22 vs 28 years; P = 0.02). Among 54 children with 560 VL visits followed from 48 to 96 months, 5 trajectory groups were identified: sustained-low (74%), mid-range (4%), periods-of-low (7%), high-to-low (7%), and sustained-high (7%). Those in the high-to-low group had younger caregivers (21 vs 29 years; P = 0.01).
Conclusions:
GBTM identified unique VL patterns among children with unsuppressed VL. Caregiver and regimen-related characteristics were associated with patterns of nonsuppression. Younger caregivers may benefit from tailored counseling to help them support child antiretroviral therapy adherence. Palatable regimens are necessary for viral suppression among children with HIV.
