Association of Antiretroviral Drug Regimen With Viral Suppression in HIV-positive Children on Antiretroviral Therapy in Eswatini. Issue 8 (August 2019)

• Record Type: Journal Article
• Authors: Chouraya, Caspian; Ashburn, Kim; Khumalo, Philisiwe; Mpango, Lydia; Mthethwa, Nobuhle; Machekano, Rhoderick; Guay, Laura; Mofenson, Lynne M.
• Is Part Of: Pediatric infectious disease journal. Volume 38:Issue 8(2019)
• Publication Date: 2019-08
• Subjects: HIV -- pediatric -- antiretroviral -- viral suppression; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000002347
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Global pediatric treatment goals are for 90% of known children living with HIV to be on antiretroviral therapy (ART), with 90% having viral suppression. We used enrollment data from a study evaluating a family-centered HIV care program in Eswatini to describe the ART histories and virologic outcomes of enrolled children living with HIV and identify factors associated with viral suppression (<1000 RNA copies/mL) and undetectability (<400 RNA copies/mL). Methods: Factors associated with viral suppression and undetectability were identified using Pearson χ 2 for categorical variables and Wilcoxon rank sum tests for continuous variables. Results: Three hundred seventy-seven children were enrolled, median age 8.5 years. Median age at HIV diagnosis was 2.1 years; at ART initiation, 2.6 years; and ART duration at enrollment, 4.1 years. Ninety-nine percent were receiving ART; 95.2% were on first-line ART and 4.8% on second-line ART. Most children (43.1%) were receiving nevirapine-based ART (median age 9.2 years), with 31.3% on lopinavir-ritonavir-based (median age 5.4 years) and 25.5%, efavirenz-based ART (median age 10.3 years). Viral suppression (<1000 copies/mL) was observed in 77.9% and undetectability (<400 copies/mL) in 73.5% of children. The only factor significantly associated with viral suppression was ART regimen, with 72.1% of children on nevirapine-based ART versus 86.7% on efavirenz-based ART virally suppressed. Conclusions: Although 99% of children enrolled in the study were receiving ART, viral suppression was observed in only 77.9%, with lowest rates among children receiving nevirapine-based ART. These findings highlight the critical importance of monitoring treatment regimen for optimizing treatment outcomes for pediatric HIV.