Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil
Rev. Soc. Bras. Med. Trop
;
53: e20200333, 2020. tab, graf
Article
in English
| SES-SP, ColecionaSUS, LILACS
| ID: biblio-1136832
ABSTRACT
Abstract INTRODUCTION:
Achieving viral suppression (VS) in children is challenging despite the exponential increase in access to antiretroviral therapy (ART). We evaluated VS in children >1 year of age and adolescents 5 years after they had begun ART, in Manaus, Amazonas state, Brazil.METHODS:
HIV-infected, ART-naive children >1 year of age between 1999 and 2016 were eligible. Analysis was stratified by age at ART initiation 1-5 y, >5-10 y, and >10-19 y. CD4+ T-cell count and viral load were assessed on arrival at the clinic, on ART initiation, and at 6 months, 1 year, 2 years, and 5 years after ART initiation. The primary outcome was a viral load <50 copies/mL 5 years after ART initiation.RESULTS:
Ultimately, 121 patients were included. The mean age at diagnosis was 4.8 years (SD 3.5), mean CD4% was 17.9 (SD 9.8), and mean viral load was 4.6 log10 copies/ml (SD 0.8). Five years after ART initiation, the overall VS rate was 46.9%. VS by patient age group was as follows 36.6% for 1-5 y, 53.3% for >5-10 y, and 30% for >10-19 y. Almost all children (90,4%) showed an increase in CD4%+ T cell count. There were no statistically significant predictors for detecting children who do not achieve VS with treatment. VS remained below 65% in all the evaluated periods.CONCLUSIONS:
Considerable immunological improvement is seen in children after ART initiation. Further efforts are needed to maintain adequate long-term VS levels and improve the survival of this vulnerable population.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
HIV Infections
Type of study:
Prognostic study
Limits:
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
Rev. Soc. Bras. Med. Trop
Year:
2020
Type:
Article
Institution/Affiliation country:
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/BR
/
Universidade do Estado do Amazonas/BR
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