Virological response and resistances over 12 months among HIV-infected children less than two years receiving first-line lopinavir/ritonavir-based antiretroviral therapy in Cote D’Ivoire and Burkina Faso: The MONOD ANRS 12206 cohort

Journal of the International AIDS Society, Volume 20, No. 1, Year 2017

Interpretation

Introduction: Lopinavir/ritonavir-based antiretroviral therapy (ART) is recommended for all HIV-infected children less than three years. However, little is known about its field implementation and effectiveness inWest Africa. We assessed the 12-month response to lopinavir/ritonavir-based antiretroviral therapy in a cohort of West African children treated before the age of two years. Methods: HIV-1-infected, ART-naive except for a prevention of mother-To-child transmission (PMTCT), tuberculosis-free, and less than two years of age children with parent’s consent were enrolled in a 12-month prospective therapeutic cohort with lopinavir/ritonavir ART and cotrimoxazole prophylaxis in Ouagadougou and Abidjan. Virological suppression (VS) at 12 months (viral load [VL] <500 copies/mL) and its correlates were assessed. Results: Between May 2011 and January 2013, 156 children initiated ART at a median age of 13.9 months (interquartile range: 7.8-18.4); 63% were from Abidjan; 53% were girls; 37% were not exposed to any PMTCT intervention or maternal ART; mother was the main caregiver in 81%; 61% were classified World Health Organization Stage 3 to 4. After 12 months on ART, 11 children had died (7%), 5 were lost-To-follow-up/withdrew (3%), and VS was achieved in 109: 70% of children enrolled and 78% of those followed-up. When adjusting for country and gender, the access to tap water at home versus none (adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.09-6.94), the mother as the main caregiver versus the father (aOR: 2.82, 95% CI: 1.03-7.71), and the increase of CD4 percentage greater than 10% between inclusion and 6 months versus <10% (aOR: 2.55, 95% CI: 1.05-6.18) were significantly associated with a higher rate of VS. At 12 months, 28 out of 29 children with VL ≥1000 copies/mL had a resistance genotype test: 21 (75%) had ≥1 antiretroviral (ARV) resistance (61% to lamivudine, 29% to efavirenz, and 4% to zidovudine and lopinavir/ritonavir), of which 11 (52%) existed before ART initiation. Conclusions: Twelve-month VS rate on lopinavir/ritonavir-based ART was high, comparable to those in Africa or high-income countries. The father as the main child caregiver and lack of access to tap water are risk factors for viral failure and justify a special caution to improve adherence in these easy-To-identify situations before ART initiation. Public health challenges remain to optimize outcomes in children with earlier ART initiation in West Africa.

AI Digest

Study Justification:

This study aimed to assess the effectiveness of lopinavir/ritonavir-based antiretroviral therapy (ART) in HIV-infected children under two years old in West Africa. This is important because little is known about the implementation and effectiveness of this treatment in this region. Understanding the virological response and resistances to this therapy can help improve treatment outcomes and optimize care for children with HIV.

Highlights:

– The study included 156 HIV-infected children under two years old who initiated lopinavir/ritonavir-based ART.
– After 12 months on ART, 78% of the children followed up achieved virological suppression (viral load

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides data on the virological response and resistances over 12 months among HIV-infected children receiving lopinavir/ritonavir-based antiretroviral therapy in West Africa. The study enrolled a cohort of children less than two years old and assessed their response to treatment. The study found a high virological suppression rate at 12 months, comparable to other regions. However, there were limitations in the study design, such as a small sample size and potential selection bias. To improve the strength of the evidence, future studies could consider increasing the sample size and implementing randomization to reduce bias.

Abstract

Materials

N/A

Innovations

I’m sorry, but I’m unable to provide recommendations for innovations to improve access to maternal health based on the information you provided. The description you provided is about the virological response and resistances among HIV-infected children receiving antiretroviral therapy. If you have any specific information or requests related to improving access to maternal health, please provide more details so that I can assist you better.

AI Innovations Description

Based on the provided description, the recommendation to improve access to maternal health would be to focus on improving adherence to antiretroviral therapy (ART) among HIV-infected pregnant women and implementing prevention of mother-to-child transmission (PMTCT) interventions. This can be achieved through the following strategies:

1. Strengthening PMTCT programs: Enhance the availability and accessibility of PMTCT services, including HIV testing and counseling, antiretroviral prophylaxis, and support for adherence to ART during pregnancy and breastfeeding.

2. Early initiation of ART: Promote early initiation of ART for HIV-infected pregnant women, as recommended by guidelines, to ensure viral suppression and reduce the risk of transmission to the child.

3. Adherence support: Provide comprehensive adherence support to pregnant women on ART, including counseling, education, reminder systems, and peer support groups. This can help improve medication adherence and achieve better virological response.

4. Integration of services: Integrate maternal health services with HIV care and treatment services to ensure seamless care and support for pregnant women living with HIV.

5. Addressing social determinants: Address social determinants of health, such as access to tap water, by improving infrastructure and providing resources to ensure a conducive environment for adherence to ART.

6. Regular monitoring and evaluation: Implement robust monitoring and evaluation systems to track the effectiveness of interventions, identify gaps, and make necessary adjustments to improve access to maternal health services.

By implementing these recommendations, it is expected that access to maternal health, including ART for HIV-infected pregnant women, can be improved, leading to better health outcomes for both mothers and their children.

AI Innovations Methodology

Based on the provided description, it seems that you are looking for innovations to improve access to maternal health. However, the description you provided is about the virological response and resistances among HIV-infected children receiving antiretroviral therapy. If you could provide more information or clarify your request, I would be happy to assist you with recommendations for innovations to improve access to maternal health.

Authors & Co-Authors

Statistics:

Citations: 12

Authors: 18

Identifiers:

DOI: 10.7448/IAS.20.1.21362

Research Areas:

Community Interventions, Environmental, Genetics and Genomics, Health System and Policy, Infectious Diseases, Maternal and Child Health, Social Determinants

Study Countries:

Multi-Countries

Study Design:

Case-Control Study, Cohort Study, randomised-control-trial

Participants Gender:

Female