Patterns of detectable viraemia among children and adults with HIV infection taking antiretroviral therapy in Zimbabwe. (January 2019)

• Record Type: Journal Article
• Authors: Sovershaeva, Evgeniya; Shamu, Tinei; Wilsgaard, Tom; Bandason, Tsitsi; Flægstad, Trond; Katzenstein, David; Ferrand, Rashida A.; Odland, Jon
• Is Part Of: International journal of infectious diseases. Volume 78(2019)
• Page Start: 65
• Page End: 71
• Publication Date: 2019-01
• Subjects: Antiretroviral therapy -- HIV -- Sub-Saharan Africa -- Viral blip -- Viral load -- Viraemia; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2018.10.019
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Limited data are available regarding the incidence of transient viraemia in children in resource-limited settings. All patterns of detectable viraemia after initial viral suppression are more common in children. Children are more prone to remain non-suppressed after 12 months of antiretroviral therapy than adults. There is a need for closer viral load monitoring of children growing up with HIV. Abstract: Objective: To investigate the incidence and predictors of viraemia among individuals on antiretroviral therapy (ART) in Harare, Zimbabwe. Methods: Children (0–19 years) and adults (>19 years) starting ART between 2013 and 2015 were followed for a median of 2.8 and 2.7 years, respectively. The incidence rates of virological failure (VF), low-level viraemia (LLV), and viral blips were assessed and the predictors of viraemia were determined using logistic and parametric survival regression analyses. Results: A total of 630 individuals initiated ART, and 19.7% of children and 5.6% of adults did not achieve viral suppression by 12 months. Younger age and CD4 count ≤200 cells/mm 3 at baseline were associated with not being virally suppressed at 12 months in adults. Among those who achieved viral suppression during the follow-up period, the incidence of VF was higher in children (4.0/100 person-years vs. 0.4/100 person-years in adults; p < 0.001), as was the incidence of LLV (1.9/100 person-years vs. 0.3/100 person-years in adults; p = 0.03). The incidence rate of blips was 10.9 per 100 person-years in children and 4.0 per 100 person-years in adults. Conclusions: Children are less likely to reach viral suppression and are at higher risk of viraemia while on ART than adults. The significance of LLV and blips needs further study.