Factors affecting virological outcome of paediatric patients on abacavir/stavudine-based first-line regimen
Date
2019
Authors
Msiza, Duduzile Precious
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Abstract
Background
Viral load (VL) testing is recommended as the preferred monitoring approach for
assessing the effectiveness of antiretroviral therapy (ART). Considering the factors
which may predispose patients to treatment failure and the high rate of virological
failure among paediatric patients, we investigate which characteristics have an effect
on virological outcomes of young children.
Objective
To identify factors associated with an increased probability of first-line ART regimen
failure and to report the rate of virological suppression in children below three years
old initiated on stavudine (d4T) - or abacavir (ABC)-based first-line regimens.
Methods
This was a retrospective cohort study conducting a secondary analysis of an existing
human immunodeficiency virus (HIV) treatment database of paediatric patients at the
Empilweni Clinic based at the Rahima Moosa Mother and Child Hospital (RMMCH) in
Johannesburg, South Africa, complemented by retrospective file review.
Results
From a population of 3,728 children attending the Empilweni clinic between 2008 and
2012, 296 were eligible for the study. The pre-treatment characteristics were gender,
age, weight and height for age z-score, viral load, and cluster of differentiation 4 (CD4)
count percentage at pre-ART. There was an upward trend in the VL suppression rate
for all the variables during the study, with an average of 24% after 6-12 months of ART
and 37% at 24-36 months of ART. The majority of patients were started on more than
five different drugs in the first year of ART (99%), with an average adherence rate of
94%. Only a small percentage had treatment interruptions. Data on tuberculosis (TB)
was available for 68% of the patients, of which 40% received HIV-TB co-treatment,
mostly (90%) in the first year of ART. A total of 60% of patients had been exposed to
prevention of mother-to-child transmission (PMTCT) therapy.
Patients on a d4T-based first-line regimen had superior VL suppression compared to
those on an ABC-based first-line regimen (p<0.0001). None of the other variables had
a significant association on the VL suppression rate.
Conclusion
The study found that there was a delay in the VL suppression rate, with most patients
still not being suppressed at 36 months of ART (40%). In this study ART regimen was
found to be the only factor associated with viral load suppression.
Description
A research report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, in partial fulfilment of
the requirements for the Degree
of
Master in Medicine
Johannesburg, 2019
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Citation
Msiza, Duduzile Precious (2019) Factors affecting virological outcome of Paediatric patients on Abacavir/Stavudine-Based First-Line Regimen, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29925>