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Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania
BACKGROUND: Achieving viral suppression (VS) for persons living with HIV is key to reaching epidemic control. We assessed the prevalence of VS and the frequency of HIV drug resistance mutations (HIVDRM) among children and adolescents living with HIV (CALHIV) in the Southern Highland zone of Tanzania...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10312299/ https://www.ncbi.nlm.nih.gov/pubmed/37279560 http://dx.doi.org/10.1093/jpids/piad040 |
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author | Khamadi, Samoel A Bahemana, Emmanuel Dear, Nicole Mavere, Caroline George, Fredy Kapene, Razack Papianus, Grace Willoughby, Walidah Chambers, Jillian Ganesan, Kavitha Mwakabanje, Iman Bacha, Jason M Desai, Priyanka Almas, Shaban Coakley, Peter D Wolfman, Vanessa Lee, Elizabeth H Hickey, Patrick W Livezey, Jeffrey Agaba, Patricia A |
author_facet | Khamadi, Samoel A Bahemana, Emmanuel Dear, Nicole Mavere, Caroline George, Fredy Kapene, Razack Papianus, Grace Willoughby, Walidah Chambers, Jillian Ganesan, Kavitha Mwakabanje, Iman Bacha, Jason M Desai, Priyanka Almas, Shaban Coakley, Peter D Wolfman, Vanessa Lee, Elizabeth H Hickey, Patrick W Livezey, Jeffrey Agaba, Patricia A |
author_sort | Khamadi, Samoel A |
collection | PubMed |
description | BACKGROUND: Achieving viral suppression (VS) for persons living with HIV is key to reaching epidemic control. We assessed the prevalence of VS and the frequency of HIV drug resistance mutations (HIVDRM) among children and adolescents living with HIV (CALHIV) in the Southern Highland zone of Tanzania. METHODS: From 2019 to 2021, we enrolled CALHIV aged 1–19 years on ART for >6 months in a cross-sectional study. Participants had viral load (VL) testing; those with VL ≥ 1000 copies/mL underwent HIVDRM testing. VS (<1000 copies/mL) prevalence estimates were calculated and robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations with potential predictors of VS. RESULTS: Of 707 participants, 595 had VS (PR: 0.84, 95% CI: 0.81–0.87). Use of an integrase strand transfer inhibitor-containing regimen (aPR 1.15, 95% CI: 0.99–1.34), age 5–9 years (aPR 1.16, 95% CI: 1.07–1.26), and seeking care at a referral center (aPR 1.12, 95% CI: 1.04–1.21) were associated with VS. Factors inversely associated with VS included having one (aPR 0.82, 95% CI: 0.72–0.92) or two or more (aPR 0.79, 95% CI: 0.66–0.94) referrals for adherence counselling, and self-reporting missing one to two (aPR 0.88, 95% CI: 0.78–0.99) or three or more (aPR 0.77, 95% CI: 0.63–0.92) doses of ART in the past month. Of 74 participants with PRRT and INT sequencing done, 60 (81.1%) had HIVDRMs at the following frequencies: 71.6%, 67.6%, 1.4%, and 4.1% for major NNRTI, NRTI, PI, and INSTI respectively. CONCLUSIONS: Higher rates of VS were observed in this cohort, and HIVDRMs were common in those without VS. This evidence supports ART optimization using dolutegravir-based regimens. However, better strategies to improve adherence are needed. |
format | Online Article Text |
id | pubmed-10312299 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-103122992023-07-01 Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania Khamadi, Samoel A Bahemana, Emmanuel Dear, Nicole Mavere, Caroline George, Fredy Kapene, Razack Papianus, Grace Willoughby, Walidah Chambers, Jillian Ganesan, Kavitha Mwakabanje, Iman Bacha, Jason M Desai, Priyanka Almas, Shaban Coakley, Peter D Wolfman, Vanessa Lee, Elizabeth H Hickey, Patrick W Livezey, Jeffrey Agaba, Patricia A J Pediatric Infect Dis Soc Original Articles BACKGROUND: Achieving viral suppression (VS) for persons living with HIV is key to reaching epidemic control. We assessed the prevalence of VS and the frequency of HIV drug resistance mutations (HIVDRM) among children and adolescents living with HIV (CALHIV) in the Southern Highland zone of Tanzania. METHODS: From 2019 to 2021, we enrolled CALHIV aged 1–19 years on ART for >6 months in a cross-sectional study. Participants had viral load (VL) testing; those with VL ≥ 1000 copies/mL underwent HIVDRM testing. VS (<1000 copies/mL) prevalence estimates were calculated and robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations with potential predictors of VS. RESULTS: Of 707 participants, 595 had VS (PR: 0.84, 95% CI: 0.81–0.87). Use of an integrase strand transfer inhibitor-containing regimen (aPR 1.15, 95% CI: 0.99–1.34), age 5–9 years (aPR 1.16, 95% CI: 1.07–1.26), and seeking care at a referral center (aPR 1.12, 95% CI: 1.04–1.21) were associated with VS. Factors inversely associated with VS included having one (aPR 0.82, 95% CI: 0.72–0.92) or two or more (aPR 0.79, 95% CI: 0.66–0.94) referrals for adherence counselling, and self-reporting missing one to two (aPR 0.88, 95% CI: 0.78–0.99) or three or more (aPR 0.77, 95% CI: 0.63–0.92) doses of ART in the past month. Of 74 participants with PRRT and INT sequencing done, 60 (81.1%) had HIVDRMs at the following frequencies: 71.6%, 67.6%, 1.4%, and 4.1% for major NNRTI, NRTI, PI, and INSTI respectively. CONCLUSIONS: Higher rates of VS were observed in this cohort, and HIVDRMs were common in those without VS. This evidence supports ART optimization using dolutegravir-based regimens. However, better strategies to improve adherence are needed. Oxford University Press 2023-06-03 /pmc/articles/PMC10312299/ /pubmed/37279560 http://dx.doi.org/10.1093/jpids/piad040 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Khamadi, Samoel A Bahemana, Emmanuel Dear, Nicole Mavere, Caroline George, Fredy Kapene, Razack Papianus, Grace Willoughby, Walidah Chambers, Jillian Ganesan, Kavitha Mwakabanje, Iman Bacha, Jason M Desai, Priyanka Almas, Shaban Coakley, Peter D Wolfman, Vanessa Lee, Elizabeth H Hickey, Patrick W Livezey, Jeffrey Agaba, Patricia A Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania |
title | Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania |
title_full | Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania |
title_fullStr | Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania |
title_full_unstemmed | Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania |
title_short | Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania |
title_sort | factors associated with viral suppression and drug resistance in children and adolescents living with hiv in care and treatment programs in southern tanzania |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10312299/ https://www.ncbi.nlm.nih.gov/pubmed/37279560 http://dx.doi.org/10.1093/jpids/piad040 |
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