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High virological failure rates in HIV-1 perinatally infected children in South Africa: A retrospective cohort study

Z N Makatini, J T Blackard, S Mda, P Miles, O Towobola

Abstract


Background. Large cohorts of HIV-1 perinatally infected children with long-term follow-up in developing countries are limited.

Objectives. To explore rates and predictors of virological failure in a paediatric cohort.

Methods. A 10-year retrospective study was conducted from January 2004 to December 2013 to determine the incidence of and factors associated with virological failure among 1 659 HIV perinatally infected children in a public sector setting in South Africa (SA). Children aged <17 years who initiated first-line antiretroviral therapy between 1 January 2004 and 31 December 2013 and had at least 5 years of HIV viral load measurements were eligible.

Results. The 1 659 children contributed 7 075 person-years of follow-up (PYFU). In the initial cohort of 2 024 children, 51.0% were male and 62.0% were aged <5 years. The incidence of virological failure was 18.7 per 100 PYFU. Virological failure was associated with male gender, death of the mother, concurrent tuberculosis treatment and World Health Organization stage IV disease. Of the 320 HIV isolates successfully amplified, 249 (77.8%) had drug resistance mutations.

Conclusions. We observed high rates of virological failure and emergence of HIV drug resistance mutations. Despite gains made by SA in the treatment of HIV, such results challenge the country’s ability to meet global targets of 90% viral suppression by 2020.

 


Authors' affiliations

Z N Makatini, Department of Virology, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

J T Blackard, Department of Virology, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Division of Digestive Diseases, University of Cincinnati College of Medicine, Ohio, USA

S Mda, Department of Virology, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa

P Miles, Health Education England, London, UK

O Towobola, Department of Virology, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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Keywords

Paediatric; Virological failure; HIV; Resistance

Cite this article

South African Medical Journal 2021;111(3):255-259. DOI:10.7196/SAMJ.2021.v111i3.15221

Article History

Date submitted: 2021-03-02
Date published: 2021-03-02

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