VIROLOGICAL RESPONSE TO EARLY COMBINED ANTIRETROVIRAL THERAPY IN HIV-INFECTED INFANTS: EVALUATION AFTER TWO YEARS OF TREATMENT IN THE PEDIACAM STUDY. (12th February 2017)

• Record Type: Journal Article
• Authors: Ndongo, Francis Ateba; Tejiokem, Mathurin Cyrille; Texier, Gaetan; Penda, Calixte; Ndiang, Suzie; Ndongo, Jean-Audrey; Guemkam, Georgette; Sofeu, Casimir Ledoux; Afumbom, Kfutwa; Faye, Albert; Msellati, Philippe; Warszawski, Josiane
• Is Part Of: BMJ global health. Volume 2(2017)Supplement 2
• Page Start: A9
• Page End: A10
• Publication Date: 2017-02-12
• Subjects: World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2016-000260.21
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Background: Little is known about virological responses to early combined antiretroviral therapy (cART) in HIV-infected infants in limited-resource settings. We estimated the probability of achieving viral suppression within two years of cART initiation, and investigated the factors associated with success. Methods: We analysed all 190 infants from the Cameroon PediaCAM study who began free cART before the age of 12 months. The main outcome measure was viral suppression (<1000 cp/mL) on at least one occasion. The other outcome measures considered were viral suppression (<400 copies/ mL) on at least one occasion and confirmed viral suppression (both thresholds) on two consecutive occasions. We used competing-risks regression for a time-to-event analysis to estimate the cumulative incidence of outcomes, and univariate and multivariate models to identify risk factors. Results: During the first 24 months of cART, 20.0% (38) of the infants died, giving a mortality rate of 11.9 deaths per 100 infant-years [95% CI: 8.1–15.7]. The probability of achieving a viral load below 1000 or 400 copies/mL was 80.0% [69.0–81.0] and 78.0% [66.0–79.0], respectively. The probability of virological suppression (with these two thresholds) on two consecutive occasions was 67.0% [56.0–70.0] and 60.0% [49.0–64.0], respectively. Virological success was associated with not having missed any doses of treatment before the visit, but not with socioeconomic and living conditions. Conclusions: The long-term daily administration of drugs to babies seems to be difficult. Mortality remained high despite early cART initiation. Future studies should focus on longer-term treatment outcomes in children still alive after two years of treatment.