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Viral failure in hiv childrens

Lucie Cluver, Franziska Meinck, Elona Toska, F Mark Orkin, Rebecca J Hodes, Lorraine Sherr
OBJECTIVE(S): HIV-positive adolescents have low ART-adherence, with consequent increased risks of mortality, morbidity and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART-adherence with adolescent violence victimisation by caregivers, teachers, peers, community members, and healthcare providers. DESIGN AND METHODS: HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected...
March 15, 2018: AIDS
Visal Moolasart, Suthat Chottanapund, Jarurnsook Ausavapipit, Sirirat Likanonsakul, Sumonmal Uttayamakul, Don Changsom, Hatairat Lerdsamran, Pilaipan Puthavathana
The RNA viral load of human immunodeficiency virus (HIV) is initially used to determine the status of the HIV infection. The goal of therapy following treatment failure is to achieve and maintain virologic suppression. A detectable viral load may relate to the progression of HIV infection. A cross-sectional survey was conducted from January 2013 to December 2014 at the Bamrasnaradura Infectious Diseases Institute, Thailand. The aim was to determine the prevalence of detectable HIV viral load (dVL) and analyze the factors associated with post-dVL conditions that occur independently of a switch to a new antiretroviral agent...
January 1, 2018: Children
Elke Wynberg, Eleri Williams, Gareth Tudor-Williams, Hermione Lyall, Caroline Foster
BACKGROUND: Efavirenz, a non-nucleoside reverse transcriptase inhibitor (NNRTI) is used globally as first-line antiretroviral therapy (ART) in combination with a dual nucleoside backbone in adults and children from 3 years of age. Up to 40% of adults taking efavirenz report central nervous system (CNS) adverse effects, and the rates of discontinuation of efavirenz-based treatment are higher than other first-line regimens. Data on efavirenz discontinuation are more limited for children and adolescents...
November 27, 2017: Clinical Drug Investigation
Stephen M Arpadi, Stephanie Shiau, Eduarda Pimentel De Gusmao, Avy Violari
INTRODUCTION: The objective of this commentary is to review considerations for implementing routine viral load (VL) monitoring programmes for HIV-infected infants and children living in low- and middle-income countries (LMIC). Since 2013, the World Health Organization (WHO) guidelines recommend VL testing as the preferred monitoring approach for all individuals treated with ART in order to assess treatment response, detect treatment failure and determine the need to switch to a second-line regimen in a timely manner...
November 2017: Journal of the International AIDS Society
Rebecca Marcus, Rashida A Ferrand, Katharina Kranzer, Linda-Gail Bekker
INTRODUCTION: The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low- and middle-income settings, particularly in sub-Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90-90-90 targets across the HIV care continuum, implementation is incomplete...
November 2017: Journal of the International AIDS Society
Alexander J Szubert, Andrew J Prendergast, Moira J Spyer, Victor Musiime, Philippa Musoke, Mutsa Bwakura-Dangarembizi, Patricia Nahirya-Ntege, Margaret J Thomason, Emmanuel Ndashimye, Immaculate Nkanya, Oscar Senfuma, Boniface Mudenge, Nigel Klein, Diana M Gibb, A Sarah Walker
BACKGROUND: Although WHO recommends viral load (VL) monitoring for those on antiretroviral therapy (ART), availability in low-income countries remains limited. We investigated long-term VL and resistance in HIV-infected children managed without real-time VL monitoring. METHODS AND FINDINGS: In the ARROW factorial trial, 1,206 children initiating ART in Uganda and Zimbabwe between 15 March 2007 and 18 November 2008, aged a median 6 years old, with median CD4% of 12%, were randomised to monitoring with or without 12-weekly CD4 counts and to receive 2 nucleoside reverse transcriptase inhibitors (2NRTI, mainly abacavir+lamivudine) with a non-nucleoside reverse transcriptase inhibitor (NNRTI) or 3 NRTIs as long-term ART...
November 2017: PLoS Medicine
Seth C Inzaule, Raph L Hamers, Job Calis, Ragna Boerma, Kim Sigaloff, Clement Zeh, Peter Mugyenyi, Sulaimon Akanmu, Tobias F Rinke de Wit
No abstract text is available yet for this article.
January 14, 2018: AIDS
Rashida A Ferrand, Victoria Simms, Ethel Dauya, Tsitsi Bandason, Grace Mchugh, Hilda Mujuru, Prosper Chonzi, Joanna Busza, Katharina Kranzer, Shungu Munyati, Helen A Weiss, Richard J Hayes
Background: Children and adolescents have poorer HIV treatment outcomes than adults. We aimed to assess the effect of community-based support for caregivers of HIV-infected children and adolescents, who are key mediators to children engaging with care, on treatment outcomes. Methods: In this open-label, randomised contolled trial, we recruited children aged 6-15 years with newly-diagnosed HIV attending primary health-care clinics in Harare, Zimbabwe. Children were randomly assigned to receive decentralised primary health-care clinic-based HIV care (control group), according to national guidelines for 18 months, or decentralised care plus structured support visits by trained community health workers (intervention group) according to national guidelines for 18 months...
November 2017: Lancet Child & Adolescent Health
Ilaria Izzo, Eugenia Quiros-Roldan, Barbara Saccani, Erika Chiari, Salvatore Casari, Emanuele Focà, Maria Chiara Pezzoli, Maria Antonia Forleo, Andrea Bonito, Raffaele Badolato, Laura Dotta, Francesco Castelli
With the development of combination antiretroviral therapy (cART), the first generation of perinatally HIV-infected children has reached young adulthood. A retrospective study was conducted on perinatally HIV-infected young adults after transition to adult care in Brescia (Northern Italy). Twenty-four patients were transferred to Infectious Disease outpatient Clinic from Pediatric Clinic between 2004 and 2016. Median age at transition was 18 years. 37.5% were male, and 75% were Italian. Median CD4(+) T-cell count was 534 cell/μL, and 9/24 presented detectable HIV-RNA at the time of transition...
November 17, 2017: AIDS Research and Human Retroviruses
Ragna S Boerma, Torsak Bunupuradah, Dorothy Dow, Joseph Fokam, Azar Kariminia, Dara Lehman, Cissy Kityo, Victor Musiime, Paul Palumbo, Annelot Schoffelen, Sam Sophan, Brian Zanoni, Tobias F Rinke de Wit, Job C J Calis, Kim C E Sigaloff
INTRODUCTION: The number of HIV-infected children and adolescents requiring second-line antiretroviral treatment (ART) is increasing in low- and middle-income countries (LMIC). However, the effectiveness of paediatric second-line ART and potential risk factors for virologic failure are poorly characterized. We performed an aggregate analysis of second-line ART outcomes for children and assessed the need for paediatric third-line ART. METHODS: We performed a multicentre analysis by systematically reviewing the literature to identify cohorts of children and adolescents receiving second-line ART in LMIC, contacting the corresponding study groups and including patient-level data on virologic and clinical outcomes...
September 15, 2017: Journal of the International AIDS Society
Benjamin Chimukangara, Justen Manasa, Rebecca Mitchell, Georgina Nyabadza, David Katzenstein, Collen Masimirembwa
Treatment of HIV has reduced HIV/AIDS-related mortality. Sustaining >90% virologic suppression in sub-Saharan Africa requires decentralized care and prevention services to rural communities. In Zimbabwe, the number of people receiving antiretroviral treatment (ART) has increased rapidly. However, access to treatment monitoring tools such as viral load and drug resistance testing is limited. We assessed virologic treatment outcomes among ART recipients in Nyamutora, a rural community receiving bimonthly ART and prevention services...
December 2017: AIDS Research and Human Retroviruses
Ayah Elmaghrabi, Elizabeth Brown, Ei Khin, Jared Hassler, Allen R Hendricks
Tubuloreticular inclusions (TRIs) are subcellular structures located within the cisternae of endoplasmic reticulum. Formation of TRIs has been linked to the exposure of excess interferon (IFN), either from endogenous or exogenous sources. In renal disease, TRIs have been most commonly associated with systemic lupus erythematosus (SLE), and human immunodeficiency virus-associated nephropathy (HIVAN). Case reports of patients with renal biopsies showing TRIs without underlying SLE or HIV are infrequent in adults, and to our knowledge none have been reported in children...
May 2017: Case Reports in Nephrology and Dialysis
Joy Chang, Amina de Sousa, Jennifer Sabatier, Mariamo Assane, Guoqing Zhang, Dulce Bila, Paula Vaz, Charity Alfredo, Loide Cossa, Nilesh Bhatt, Emilia H Koumans, Chunfu Yang, Emilia Rivadeneira, Ilesh Jani, James C Houston
Quantitative plasma viral load (VL) at 1000 copies /mL was recommended as the threshold to confirm antiretroviral therapy (ART) failure by the World Health Organization (WHO). Because of ongoing challenges of using plasma for VL testing in resource-limited settings (RLS), especially for children, this study collected 717 DBS and paired plasma samples from children receiving ART ≥1 year in Mozambique and compared the performance of DBS using Abbott's VL test with a paired plasma sample using Roche's VL test...
2017: PloS One
Premrutai Thitilertdecha, Ladawan Khowawisetsut, Palanee Ammaranond, Poonsin Poungpairoj, Varangkana Tantithavorn, Nattawat Onlamoon
Antiretroviral therapy (ART) is generally prescribed to patients with human immunodeficiency virus (HIV) infection with vaccination introduced to prevent disease complications. However, little is known about the influence of immunization on T cell subsets' distribution during the course of infection. This study aims to identify the impact of viral replication and immunization on naïve, effector, effector memory, and central memory T cell subpopulations in ART-treated HIV-infected children. Fifty patients were recruited and injected intramuscularly with influenza A (H1N1) 2009 vaccine on the day of enrollment (day 0) and day 28...
2017: Disease Markers
Haseena Cassim, Kennedy Otwombe, Erica Lazarus, Afaaf Liberty, Glenda E Gray, Oppel B W Greeff, Avy Violari
INTRODUCTION: The current World Health Organization guideline for first line antiretroviral therapy (ART) in HIV-infected children recommends the use of abacavir and lamivudine as nucleoside backbones and no longer includes stavudine. We compared treatment outcomes with abacavir (ABC) versus stavudine (d4T) in a cohort of HIV-1 infected children 6 and 12 months after antiretroviral therapy was initiated. METHODS: This was a retrospective case-cohort study, using programmatic data from children enrolled in the Paediatric Wellness Programme at the Perinatal HIV Research Unit in Soweto, South Africa between 2005 and 2013...
2017: PloS One
Cissy Kityo, Ragna S Boerma, Kim C E Sigaloff, Elizabeth Kaudha, Job C J Calis, Victor Musiime, Sheila Balinda, Rita Nakanjako, T Sonia Boender, Peter N Mugyenyi, Tobias F Rinke de Wit
Background: Pretreatment HIV drug resistance (PDR) can impair virological response to ART, jeopardizing effective treatment for children. Methods: Children aged ≤12 years initiated first-line ART in Uganda during 2010-11. Baseline and 6 monthly viral load (VL) and genotypic resistance testing if VL >1000 copies/mL was done. The 2015 IAS-USA mutation list and Stanford algorithm were used to score drug resistance mutations (DRMs) and susceptibility. Virological failure (VF) was defined as two consecutive VLs >1000 copies/mL or death after 6 months of ART...
September 1, 2017: Journal of Antimicrobial Chemotherapy
Rogers Ssebunya, Rhoda K Wanyenze, Heather Lukolyo, Milton Mutto, Grace Kisitu, Pauline Amuge, Albert Maganda, Adeodata Kekitiinwa
BACKGROUND: Viral suppression is a critical indicator of HIV treatment success. In the era of test-and-start, little is known about treatment outcomes and time to undetectable viral loads. This study compares treatment outcomes, median times to achieve undetectable viral loads and its predictors under different antiretroviral (ART) treatment initiation schedules (i.e. within seven days of enrolment or later). METHODS: A retrospective cohort of 367 patients <18 years who enrolled in care between January 2010 and December 2015 with a baseline viral load of >5000 copies/ml were followed up for 60 months...
June 19, 2017: BMC Infectious Diseases
Mathieu Maheu-Giroux, Juan F Vesga, Souleymane Diabaté, Michel Alary, Stefan Baral, Daouda Diouf, Kouamé Abo, Marie-Claude Boily
BACKGROUND: National responses will need to be markedly accelerated to achieve the ambitious target of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This target aims for 90% of HIV-positive individuals to be aware of their status, for 90% of those aware to receive antiretroviral therapy (ART), and for 90% of those on treatment to have a suppressed viral load by 2020, with each individual target reaching 95% by 2030. We aimed to estimate the impact of various treatment-as-prevention scenarios in Côte d'Ivoire, one of the countries with the highest HIV incidence in West Africa, with unmet HIV prevention and treatment needs, and where key populations are important to the broader HIV epidemic...
June 2017: PLoS Medicine
Ivar P E Gondrie, Diane E T Bastiaans, Pieter L A Fraaij, Gertjan J A Driessen, Linda C van der Knaap, Eline G Visser, Petronette van Jaarsveld, Ronald de Groot, Nico G Hartwig, David M Burger, Annemarie M C van Rossum
BACKGROUND: The use of lopinavir/ritonavir once-daily (LPV/r QD) has not been approved for children. Good short-term clinical, virologic and immunologic outcomes have been observed in children on LPV/r QD. METHODS: We evaluated the long-term effectiveness of a LPV/r QD containing regimen in HIV-1-infected children in clinical practice. Selected children (0-18 years of age) with an undetectable HIV-1 RNA viral load (<50 copies/mL) for at least 6 months on a twice-daily LPV/r-containing regimen switched to LPV/r QD...
October 2017: Pediatric Infectious Disease Journal
A Tariro Makadzange, F Kathryn Boyd, Benjamin Chimukangara, Collen Masimirembwa, David Katzenstein, Chiratidzo E Ndhlovu
Although Roche COBAS Ampliprep/COBAS TaqMan (CAP/CTM) systems are widely used in sub-Saharan Africa for early infant diagnosis of HIV from dried blood spots (DBS), viral load monitoring with this system is not practical due to nonspecific extraction of both cell-free and cell-associated viral nucleic acids. A simplified DBS extraction technique for cell-free virus elution using phosphate-buffered saline (PBS) may provide an alternative analyte for lower-cost quantitative HIV virus load (VL) testing to monitor antiretroviral therapy (ART)...
July 2017: Journal of Clinical Microbiology
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