British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 4, Issue.: 15 (21-31 May)
Original Research Article
Risk Factors for First-line Antiretroviral Treatment Failure in HIV-1 Infected Children Attending Jos University Teaching Hospital, Jos, North Central Nigeria
Augustine O. Ebonyi1*, Stephen Oguche1, Emeka U. Ejeliogu1, Sylvanus E. Okpe1, Oche O. Agbaji2, Solomon A. Sagay3, Prosper Okonkwo4, John A. Idoko5 and Phyllis Kanki6
1Department of Paediatrics, University of Jos/ Jos University Teaching Hospital, Jos. Nigeria
2Department of Medicine, University of Jos/ Jos University Teaching Hospital, Jos. Nigeria.
3Department of Obstetrics and Gynaecology, University of Jos/ Jos University Teaching Hospital, Jos, Nigeria.
4AIDS Prevention Initiative in Nigeria (APIN) LLC, Abuja, Nigeria.
5National Agency for the Control of AIDS (NACA), Abuja, Nigeria.
6Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
Aim: To determine risk factors for first-line antiretroviral treatment failure in HIV-1 infected children attending Jos University Teaching Hospital, Jos.
Study Design: Retrospective cohort study.
Place and Duration of Study: Paediatric HIV clinic at the Jos University Teaching Hospital, Jos, between February 2006 and December 2010.
Methodology: Data on demographic, clinical and laboratory variables for 580 HIV-1 infected children aged 2 months to 15 years on antiretroviral therapy (ART) were analysed. A comparison of the data on children with and without treatment failure was made. Variables associated with treatment failure in a univariate analysis were then fit in a multivariate logistic model to determine the factors that were associated with treatment failure.
Results: The rate of treatment failure among the children was 18.8%. Previous antiretroviral drugs (ARV) exposure for treatment, not receiving cotrimoxazole prophylaxis before commencement of ART and having severe immune suppression at HIV diagnosis were the factors independently associated with treatment failure. Children with previous ARV exposure for treatment were 4 times more likely to fail treatment compared to those without previous exposure (AOR=4.20 (1.93-9.15); p <0.001). Children who did not receive cotrimoxazole prophylaxis were twice more likely to develop treatment failure compared to those who did (AOR=2.26 (1.06-4.79); p=0.03) and children with severe immune suppression at HIV diagnosis were twice more likely to develop treatment failure compared to those without severe immune suppression (AOR=2.34 (1.47-3.72); p<0.001).
Conclusion: HIV-infected children with previous ARV exposure for treatment and severe immune suppression should be monitored closely and given frequent adherence counseling to minimize the risk of treatment failure. Cotrimoxazole prophylaxis should be encouraged in HIV-infected children while they await commencement of ART, which may improve ART adherence and thus reduce the risk of treatment failure.
HIV-1; antiretroviral; treatment failure; cotrimoxazole prophylaxis; ARV exposure; paediatric ART; Africa.
Full Article - PDF
DOI : 10.9734/BJMMR/2014/8869