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Viral failure in hiv childrens

Thahira Jamal Mohamed, Sirinya Teeraananchai, Stephen J Kerr, Wanatpreeya Phongsamart, Nik Khairulddin Nik Yusoff, Rawiwan Hansudewechakul, Penh Sun Ly, Lam Van Nguyen, Tavitiya Sudjaritruk, Pagakrong Lumbiganon, Viet Chau Do, Nia Kurniati, Nagalingeswaran Kumarasamy, Dewi Kumara Wati, Moy Siew Fong, Revathy Nallusamy, Azar Kariminia, Annette Sohn
<b>Background.</b> We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. <b>Methods.</b> Data from a regional cohort of 16 clinical programs in 6 Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and >1 of the following: 1) reported treatment failure by local criteria, 2) switch of >1 additional drug, or 3) a preceding HIV viral load (VL) ≥1,000 copies/mL...
October 19, 2016: AIDS Research and Human Retroviruses
Susan Purchase, Jayne Cunningham, Monika Esser, Donald Skinner
The burden of paediatric HIV in South Africa is extremely high. Antiretrovirals (ARVs) are now widely accessible in the country and the clinical emphasis has shifted from initiation of treatment to retention in care. This study describes the cumulative virological failure rate amongst children on ARVs in a peri-urban clinic, and suggests ways in which clinics and partners could improve treatment outcomes. The study was conducted by the non-profit organisation HOPE Cape Town Association. A retrospective file audit determined the cumulative virological failure rate, that is, the sum of all children with a viral load >1000 copies/ml, children on monotherapy, children who had stopped treatment, children lost to follow-up (LTFU) and children who had died...
September 2016: African Journal of AIDS Research: AJAR
Lukas Muri, Anna Gamell, Alex J Ntamatungiro, Tracy R Glass, Lameck B Luwanda, Manuel Battegay, Hansjakob Furrer, Christoph Hatz, Marcel Tanner, Ingrid Felger, Thomas Klimkait, Emilio Letang
OBJECTIVE: To investigate the prevalence and determinants of virologic failure (VF) and acquired drug resistance-associated mutations (DRM) in HIV-infected children and adolescents in rural Tanzania. DESIGN: Prospective cohort study with cross-sectional analysis. METHODS: All children ≤18 years attending the paediatric HIV Clinic of Ifakara and on antiretroviral treatment (ART) for ≥12 months were enrolled. Participants with VF were tested for HIV-DRM...
September 24, 2016: AIDS
Ragna S Boerma, Cissy Kityo, T Sonia Boender, Elizabeth Kaudha, Joshua Kayiwa, Victor Musiime, Andrew Mukuye, Mary Kiconco, Immaculate Nankya, Lilian Nakatudde, Peter N Mugyenyi, Michael Boele van Hensbroek, Tobias F Rinke de Wit, Kim C E Sigaloff, Job C J Calis
BACKGROUND: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens. METHODS: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml. RESULTS: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch...
September 15, 2016: Journal of Tropical Pediatrics
A Judd, R Lodwick, A Noguera-Julian, D M Gibb, K Butler, D Costagliola, C Sabin, A van Sighem, B Ledergerber, C Torti, A Mocroft, D Podzamczer, M Dorrucci, S De Wit, N Obel, F Dabis, A Cozzi-Lepri, F García, N H Brockmeyer, J Warszawski, M I Gonzalez-Tome, C Mussini, G Touloumi, R Zangerle, J Ghosn, A Castagna, G Fätkenheuer, C Stephan, L Meyer, M A Campbell, G Chene, A Phillips
OBJECTIVES: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. METHODS: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement...
September 14, 2016: HIV Medicine
Retsilisitsoe R Moholisa, Michael Schomaker, Louise Kuhn, Sandra Castel, Lubbe Wiesner, Ashraf Coovadia, Renate Strehlau, Faeezah Patel, Francoise Pinillos, Elaine J Abrams, Gary Maartens, Helen McIlleron
BACKGROUND: Adequate exposure to antiretroviral drugs is necessary to achieve and sustain viral suppression. However, the target antiretroviral concentrations associated with long term viral suppression have not been adequately defined in children. AIM: We assessed the relationship between plasma lopinavir or nevirapine concentrations and the risk of subsequent viremia in children initially suppressed on antiretroviral therapy. METHODS: After an induction phase of antiretroviral treatment, 195 children with viral suppression (viral load ≤400 copies/mL) were randomized to continue a lopinavir/ritonavir-based regimen or to switch to a nevirapine-based regimen (together with lamivudine and stavudine)...
August 31, 2016: Pediatric Infectious Disease Journal
Chet Raj Ojha, Geeta Shakya, Shyam Prakash Dumre
Antiretroviral therapy (ART) has increased the life span of the people living with HIV (PLHIV), but their virological and immunological outcomes are not well documented in Nepal. The study was conducted at a tertiary care center including 826 HIV-1 seropositive individuals undergoing ART for at least six months. Plasma viral load (HIV-1 RNA) was detected by Real Time PCR and CD4(+) T-lymphocyte (CD4(+)) counts were estimated by flow cytometry. The mean CD4(+) count of patients was 501 (95% CI = 325-579) cells/cumm, but about 35% of patients had CD4(+) T cell counts below 350 cells/cumm...
2016: BioMed Research International
Annouschka M Weijsenfeld, Colette Smit, Sophie Cohen, Ferdinand W N M Wit, Michelle Mutschelknauss, Linda C van der Knaap, Laura M van Zonneveld, Bert J Zomer, Nike Nauta, Joke C Patist, Marien H J Kuipers-Jansen, Esther P Smit, Charlotte Blokhuis, Dasja Pajkrt
BACKGROUND: As a result of effective combination antiretroviral therapy (cART) and advanced supportive healthcare, a growing number of human immunodeficiency virus (HIV)-infected children survive into adulthood. The period of transition to adult care is often associated with impaired adherence to treatment and discontinuity of care. We aimed to evaluate virological and social outcomes of HIV-infected adolescents and young adults (AYAs) before and after transition, and explore which factors are associated with virological failure...
October 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Bronwyne Coetzee, Ashraf Kagee, Ruth Bland
For children younger than five years, caregivers are responsible for the measurement and administration of antiretroviral medication doses to children. Failure to adhere to the regimen as prescribed may lead to high viral loads (VLs), immune suppression and ultimately drug resistance. In the content of this study, adherence refers to adequate dosing of the medication by a caregiver. Acquired drug resistance to antiretroviral therapy (ART) is prevalent amongst children in South Africa, and poor adherence to the dosing regimen by caregivers may be associated with this problem...
March 2016: AIDS Care
E Tchiakpe, A Hounto-Ogouyemi, H Diop Ndiaye, A A M Diouara, A K Aïssi, R K Keke, A A Kpangon, B Lafia, D Métadokou, B Bouraïma, D Anthony, A Hounsinou, M J Alao, A Azondekon, A D Ahouidi, A K Bei, M A S Mbengue, C Touré Kane, D M Zannou
The goal of this study was to evaluate using the molecular diagnosis, infection transmission rate of HIV in children born to HIV-1 positive mothers as part of the prevention of mother-to-child transmission (PMTCT) in Benin. The sample consisted of 524 dried blood spots (DBS) of children born to HIV-1 positive mothers, from 30 sites (PMTCT) taken between October 2009 and June 2010. The diagnosis of HIV-1 was performed by the qualitative detection of viral nucleic acids (RNA and DNA) in DBS on filter paper using the Abbott RealTime(®) HIV-1 Qualitative assay...
August 2016: Bulletin de la Société de Pathologie Exotique
T Sonia Boender, Cissy M Kityo, Ragna S Boerma, Raph L Hamers, Pascale Ondoa, Maureen Wellington, Margaret Siwale, Immaculate Nankya, Elizabeth Kaudha, Alani Sulaimon Akanmu, Mariette E Botes, Kim Steegen, Job C J Calis, Tobias F Rinke de Wit, Kim C E Sigaloff
OBJECTIVES: Limited availability of viral load (VL) monitoring in HIV treatment programmes in sub-Saharan Africa can delay switching to second-line ART, leading to the accumulation of drug resistance mutations (DRMs). The objective of this study was to evaluate the accumulation of resistance to reverse transcriptase inhibitors after continued virological failure on first-line ART, among adults and children in sub-Saharan Africa. METHODS: HIV-1-positive adults and children on an NNRTI-based first-line ART were included...
October 2016: Journal of Antimicrobial Chemotherapy
Lola Falcon-Neyra, Claudia Palladino, María Luisa Navarro Gómez, Pere Soler-Palacín, María Isabel González-Tomé, Santiago J De Ory, Marie Antoinette Frick, Clàudia Fortuny, Antoni Noguera-Julian, Elena Bermúdez Moreno, Juan Luis Santos, Peter Olbrich, Luis F López-Cortés, Verónica Briz, Olaf Neth
To assess the safety and efficacy of rilpivirine in combination with emtricitabine and tenofovir (RPV/FTC/TDF) as a once-daily single-tablet regimen (STR) in HIV-1-infected children and adolescents we performed a multicenter case series study of HIV-1-infected patients. Inclusion criteria were initiation of therapy with RPV/FTC/TDF before the age of 18. Patients were divided into undetectable viral load (uVL) group, HIV-1 RNA < 20 copies/mL on stable combined antiretroviral therapy (cART), and detectable viral load (dVL) group, HIV-1 RNA ≥ 20 copies/mL at RPV/FTC/TDF initiation...
June 2016: Medicine (Baltimore)
Pope Kosalaraksa, David C Boettiger, Torsak Bunupuradah, Rawiwan Hansudewechakul, Sarun Saramony, Viet C Do, Tavitiya Sudjaritruk, Nik K N Yusoff, Kamarul A M Razali, Lam V Nguyen, Revathy Nallusamy, Siew M Fong, Nia Kurniati, Khanh H Truong, Annette H Sohn, Kulkanya Chokephaibulkit
BACKGROUND: Regular CD4 count testing is often used to monitor antiretroviral therapy efficacy. However, this practice may be redundant in children with a suppressed human immunodeficiency virus (HIV) viral load. METHODS: Study end points were as follows: (1) a CD4 count <200 cells/mm(3) followed by a CD4 count ≥200 cells/mm(3) (transient CD4 <200); (2) CD4 count <200 cells/mm(3) confirmed within 6 months (confirmed CD4 <200); and (3) a new or recurrent World Health Organization (WHO) stage 3 or 4 illness (clinical failure)...
June 13, 2016: Journal of the Pediatric Infectious Diseases Society
Elizabeth M Dufort, Allison K DeLong, Marita Mann, Winstone M Nyandiko, Samuel O Ayaya, Joseph W Hogan, Rami Kantor
We evaluated treatment failure misclassification in human immunodeficiency virus-infected Kenyan children whose targeted viral loads were determined after suspected immunologic/clinical failure according to 2006 and 2010/2013 World Health Organization guidelines. The misclassification rate was 21% for the 2006 guidelines and 46% for the 2010/2013 guidelines, which supports current recommendations for routine viral load monitoring but not necessarily the proposed CD4 thresholds.
April 29, 2016: Journal of the Pediatric Infectious Diseases Society
Mounerou Salou, Anoumou Y Dagnra, Christelle Butel, Nicole Vidal, Laetitia Serrano, Elom Takassi, Abla A Konou, Spero Houndenou, Nina Dapam, Assetina Singo-Tokofaï, Palokinam Pitche, Yao Atakouma, Mireille Prince-David, Eric Delaporte, Martine Peeters
INTRODUCTION: Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. METHODS: HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014)...
2016: Journal of the International AIDS Society
Andrzej Bienczak, Paolo Denti, Adrian Cook, Lubbe Wiesner, Veronica Mulenga, Cissy Kityo, Addy Kekitiinwa, Diana M Gibb, David Burger, A Sarah Walker, Helen McIlleron
BACKGROUND: Owing to insufficient evidence in children, target plasma concentrations of efavirenz are based on studies in adults. Our analysis aimed to evaluate the pediatric therapeutic thresholds and characterize the determinants of virological suppression in African children. METHODS: We analyzed data from 128 African children (aged 1.7-13.5 years) treated with efavirenz, lamivudine, and one among abacavir, stavudine, or zidovudine, and followed up to 36 months...
October 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Allison L Agwu, Tzy-Jyun Yao, Susan H Eshleman, Kunjal Patel, Wei Huang, Sandra K Burchett, George K Siberry, Russell B Van Dyke
BACKGROUND: Perinatally HIV-infected (PHIV) children and youth are often heavily treatment-experienced, with resultant antiretroviral resistance and limited treatment options. For those with virologic failure (VF), new agents such as CCR5 (R5) antagonists may be useful; however, reports of R5 antagonist susceptibility in children have mostly relied on genotypic testing, which may not accurately reflect the phenotypic tropism of the viral populations. We characterized phenotypic coreceptor usage among PHIV children and youth with VF on antiretroviral treatment to identify predictors of CXCR4 (X4) tropism which preclude R5 antagonist use...
July 2016: Pediatric Infectious Disease Journal
Gloria Huerta-García, José G Vazquez-Rosales, José A Mata-Marín, Leoncio Peregrino-Bejarano, Eric Flores-Ruiz, Fortino Solórzano-Santos
BACKGROUND: Genotyping tests were developed to attenuate the impact of viral resistance. Information about the efficacy in genotype base antiretroviral therapy in children is rare and even more in low- and middle-income countries. METHODS: Sixteen children with antiretroviral therapy (ART) failure and triple-class drug-resistant viruses were included in this study. Protease and retrotranscriptase genotypes were available for all patients. Switch of ART regimen was guided by genotyping data...
July 2016: Pediatric Research
Cody S Nelson, Justin Pollara, Erika L Kunz, Thomas L Jeffries, Ryan Duffy, Charles Beck, Lisa Stamper, Minyue Wang, Xiaoying Shen, David J Pickup, Herman F Staats, Michael G Hudgens, Thomas B Kepler, David C Montefiori, M Anthony Moody, Georgia D Tomaras, Hua-Xin Liao, Barton F Haynes, Guido Ferrari, Genevieve G A Fouda, Sallie R Permar
UNLABELLED: Maternal vaccination to induce anti-HIV immune factors in breast milk is a potential intervention to prevent postnatal HIV-1 mother-to-child transmission (MTCT). We previously demonstrated that immunization of lactating rhesus monkeys with a modified vaccinia Ankara (MVA) prime/intramuscular (i.m.) protein boost regimen induced functional IgG responses in milk, while MVA prime/intranasal (i.n.) boost induced robust milk Env-specific IgA responses. Yet, recent studies have suggested that prevention of postnatal MTCT may require both Env-specific IgA and functional IgG responses in milk...
May 15, 2016: Journal of Virology
Hubert Barennes, Kang Virak, François Rouet, Yves Buisson, Michel Strobel, Ung Vibol
BACKGROUND: Little is known about the efficacy of first and and second-line antiretroviral therapies (ART) for HIV-1 infected children in resource limited Southeast Asian settings. Previous studies have shown that orphans are at a higher risk for virological failure (VF) in Cambodia. Consequently most of them required transfer to second-line ART. We assessed the factors associated with VF among HIV-1 infected children who were either under first-line (mostly 3TC + D4T + NVP) or under second-line (mostly ABC + DDI + LPV) therapies at a referral hospital in Cambodia...
2016: BMC Research Notes
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