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Predictors of Virological Failure on First-Line Antiretroviral Therapy among Children in a Referral Pediatric Center in Cameroon.

Njom Nlend, Anne Esther MD; Nga Motaze, Annie MD; Tetang Ndiang, Suzie MD; Fokam, Joseph PhD
Pediatric Infectious Disease Journal: Post Acceptance: June 28, 2017
doi: 10.1097/INF.0000000000001672
HIV Reports: PDF Only

Background: Suboptimal response to antiretroviral therapy (ART) is common among children living with HIV (CHIV) in resource-limited settings (RLS). We sought to assess virological failure (VF), time for switching to second-line regimens, and factors associated with VF in CLHIV receiving first-line ART in Cameroon.

Methods: An observational cohort-study was conducted in 375 CLHIV initiating a first-line ART and treated for >=6months at the National Social Insurance Fund Hospital in Yaounde-Cameroon, from 2009-2013. Using logistic regression, predictors of VF and delayed switch were assessed by univariate and multivariate analysis. P<0.05 was considered statistically significant.

Results: Overall, 17% (64/375) CLHIV experienced VF on first-line ART, after a median-time [interquartile range, IQR] of 28 [IQR: 22-38] months. After VF, median time to switching from first- to second-line ART was 20 [IQR: 8-24] months. In multivariate analysis, VF was associated with male gender (adjusted odds ratio, AOR: 0.36, 95%CI 0.19-0.71, p=0.003), motherless children (AOR: 2.9, 95% CI [1.3-6.06], p=0.005), and treatment with stavudine-containing compared to zidovudine-containing regimens (p=0.022). Overall, male gender, orphanhood (motherless), and treatment with stavudine-containing regimens predicted VF at a rate of 70% (area under curve =0.70).

Conclusion: VF on first-line pediatric ART is common, and switching children failing first-line to second-line ART is considerably delayed. These results suggest performance of pediatric ART program can be improved by targeting orphans, adapting counseling for male children, complete phasing-out of stavudine, and ensuring timely switch to second-line regimens.

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