Outcomes of HIV-infected children on antiretroviral therapy for at least 10 years at the Essos Hospital Centre, Cameroon: contributing to the elimination of paediatric AIDS in tropical settings.
Anne Esther Njom Nlend, Joseph Fokam, Suzanne Mekoui, Jeannette Epée Ngoué, Annie Carole Nga Motaze, Vittorio Colizzi, Carlo-Federico Perno, Alexis Ndjolo, Gregory-Edie Halle-Ekane, Arsene Sandie
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引用次数: 0
Abstract
Evidence on long-term outcomes of children receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is of utmost importance to optimize current and future therapeutic strategies for HIV. We sought to ascertain the long-term responses among ART-experienced children and their potential implications. A retrospective, observational, facility-based cohort study was conducted among 136 ART-experienced children monitored for 10 years (2007-2017) at the Essos Hospital Centre in Yaoundé, Cameroon. Primary outcomes were good clinical response defined as the World Health Organization (WHO) clinical stage 1/2, immune restoration as CD4 >500 cells/mm3, viral suppression (VS) as viral load (VL) <1000, or viral undetectability as VL <40 copies/ml at the last follow-up and their predictors (P < .05). At ART initiation among the 90 eligible children, median (interquartile range) age was 29.5 (11-60) months, 53.3% were males, 34.5% were at WHO clinical stage 1/2, median-CD4 was 497 cells/mm3, and initial ART-regimens were mainly zidovudine-lamivudine-nevirapine (85.5%) and zidovudine-lamivudine-efavirenz (12.2%). After 10 years of follow-up, 36.7% were switched to protease-based ART regimens, those at WHO clinical stage 1/2 improved to 75.5%; median-CD4 increased to 854 cells/mm3; 83.3% achieved VS, while only 10% achieved viral undetectability. Following multivariate analysis, no predictor of VS or immune recovery was identified (P > .05). In this LMIC, long-term outcomes of children on ART appear encouraging, characterized by moderate VS rate and immune recovery. However, challenges in achieving viral undetectability indicate continuous viral replication and risks of drug resistance emergence that may jeopardize effectiveness of future paediatric ART strategies.
期刊介绍:
The Journal of Tropical Pediatrics provides a link between theory and practice in the field. Papers report key results of clinical and community research, and considerations of programme development. More general descriptive pieces are included when they have application to work preceeding elsewhere. The journal also presents review articles, book reviews and, occasionally, short monographs and selections of important papers delivered at relevant conferences.