Prospective Long-term Outcomes of a Cohort of Ugandan Children With Laboratory Monitoring During Antiretroviral Therapy
The Pediatric Infectious Disease Journal, 07/31/2012
Kekitiinwa A et al. – These prospective long–term findings support the general use of monitoring HIV–1 RNA levels for the management of children on ART and the adoption of a clearer definition for virologic failure and better guidelines for managing children with unsuppressed HIV–1 RNA levels.Methods
- One hundred eight children initiating ART were enrolled into this study.
- These children had comprehensive laboratory monitoring, including HIV-1 RNA level determination and genotype analysis (where appropriate), CD4% plus absolute counts and safety laboratory measurements performed before starting therapy and at regular intervals after receiving ART.
- Kaplan-Meier statistics were used to examine predictors of survival and virologic failure.
- Viral genotype analysis was performed on samples obtained from children having virologic failure to determine the emergence of mutations.
- Clinically, there was no difference in the 3-year survival between cohort receiving consistent laboratory monitoring and a matched historical clinic cohort not routinely receiving laboratory monitoring.
- However, 34% of children receiving ART demonstrated virologic failure. Eleven of these children received second-line ART, and all responded with an undetectable HIV-1 RNA level and an increase in CD4 count.
- Children remaining on a failing antiretroviral regimen accumulated resistance mutations.