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Predictors of Virologic Failure on First-line Antiretroviral Therapy Among Children in a Referral Pediatric Center in Cameroon

Njom Nlend, Anne Esther MD*†; Motaze, Annie Nga MD*; Ndiang, Suzie Tetang MD*; Fokam, Joseph PhD†‡§

The Pediatric Infectious Disease Journal: November 2017 - Volume 36 - Issue 11 - p 1067–1072
doi: 10.1097/INF.0000000000001672
HIV Reports

Background: Suboptimal response to antiretroviral therapy (ART) is common among children living with HIV (CLHIV) in resource-limited settings. We sought to assess virologic 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 ≥6 months at the National Social Insurance Fund Hospital in Yaoundé-Cameroon from 2009 to 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 of 28 (interquartile range: 22–38) months. After VF, median time to switching from first- to second-line ART was 20 (interquartile range: 8–24) months. In multivariate analysis, VF was associated with male gender (adjusted odds ratio: 0.36; 95% confidence interval: 0.19–0.71; P = 0.003), motherless children (adjusted odds ratio: 2.9; 95% confidence interval: 1.3–6.06; P = 0.005) and treatment with stavudine-containing compared with 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.

From the *National Social Insurance Fund Hospital, Pediatric Service, Yaoundé, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon; and §Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.

Accepted for publication March 16, 2017.

This study was sponsored by the GlaxoSmithKline (GSK) Foundation through funding allocated for plasma viral load measurement.

The authors have no conflicts of interest or further funding to disclose.

Address for correspondence: Anne Esther Njom Nlend, MD, National Social Insurance Fund Hospital, Pediatric Service, Yaoundé, Cameroon. E-mail: or Joseph Fokam, PhD, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. E-mail:

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