Antiretroviral therapy monitoring among HIV-1 vertically infected children: implications of long term treatment on disease progression

Abstract

Background: Antiretroviral therapy (ART) has mitigated the impact of HIV-1/AIDS among infected individuals in resource-poor settings. However, ART failure due to treatment interruption, bad adherence and emergence of drug resistance mutations has been a negative consequence. According to revised world health organization treatment guidelines in 2010, once a patient is found to be failing ART, change of regimen should be considered.

Objective: To determine response to ART and evaluate the outcome among HIV-1 vertically-infected Kenyan children,

Methodology: This was a longitudinal study involving 103 children. CD4⁺T-cell counts and plasma HIV-1 RNA load (VL) were determined biannually using the FACS caliber machine (Becton Dickinson) and Amplicor version 1.5, respectively, according to the manufacturers’ instructions. Further, drug-resistance mutations in the HIV pol gene were determined using an in-house protocol and results analyzed by comparing the mutations with the latest International AIDS Society (2011) mutation list and the Stanford University HIV database.

Results: After an average of 4.2±2.0 years, 43 (41.7%) children failed first-line ART (VL＞5000 copies/ml) and changed to second-line regimen. A further follow up of those on second-line treatment showed one child (2.3%) with ART failure after 3.7±1.1 years. The remaining 60 children were on first-line ART for an average of 6.5±2.4 years. Of these, four had detectable viral load with emergence of drug resistance mutations.

Conclusion: Even though the children failed first-line ART, second-line regimen was effective enough (97.7% treatment success in 3.7 years). With proper monitoring, ART among children in these settings is feasible and comparable to adults. However, salvage therapy options remain a challenge.