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Virologic and Immunologic Response to ART and Predictors of HIV-1 Drug Resistance in Children Receiving Treatment in Abidjan, Côte d’Ivoire
John N. Nkengasong*1,2, John N. Nkengasong*1,2, C Adje-Toure2, D Hanson1, N Talla-Nzussouo2, M Y Borget2, L Ya Kouadio2, O Tossou2, P Fassinou3, A Kadio4, M Nolan1,2, and M Nolan1,2
1Global AIDS Prgm, CDC, Atlanta, GA, US; 2Project RETRO-CI, Abidjan, Côte d'Ivoire; 3Univ Teaching Hosp of Yopougon, Cote d'Ivoire; and 4Univ Teaching Hosp of Treichville, Cote d'Ivoire
Background: Studies in developed countries have shown that
although HIV-1-related deaths are reduced in ART-treated adults and infants,
differences exist with respect to virologic and immunologic responses to
therapy. In children receiving therapy, viremia is
relatively poorly suppressed and the phase II decay rate in viral load is
slower than in adults, despite a rise in CD4 counts. We describe changes in
HIV-1 viral load, CD4 T-lymphocyte percentages, incidence of drug resistance
and factors associated with drug resistance for children receiving ART for
approximately 1 year in Abidjan.
Methods: Between
August 1998 and September 2003, 395 children were receiving ART in the national
care and treatment program. We selected
and analyzed data for viral load, CD4 counts, and occurrence of drug resistance
from the 134 HIV-infected children (34%) who were ART-naive at program entry, had 2 or more follow-up visits per year, were
prescribed ART for >300 days, and had complete blood specimens.
Results: At treatment initiation, children had advanced HIV
disease with 80% had a CD4% <15%. Median viral RNA load was 5.6 log. Median age at treatment initiation was 7 years; only
25% of patients were <4 years of age. At 1 year of therapy, 72 (54%)
children had undetectable viral load with an estimated 1-year viral load decline of 1.9 log10
copies/mL and CD4 percentage increase of 10.9%. The estimated 1-year
cumulative probability for developing any class of drug resistance was 0.44
(95%CI, 0.35 to 0.53). In a multivariate
analysis, the magnitude of virologic response to therapy was inversely
associated with development of drug resistance (p <0.001). Children with lesser CD4 cell rise from baseline
values and those who initiated dual therapy were also more likely to develop
drug resistance (p = 0.05 and 0.02,
respectively)
Conclusions: This study provides important
information about response to therapy among children in Ivory Coast. Strategies that improve response
to therapy will likely reduce the risk of development of drug resistance and
improve long-term outcomes of therapy.
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