Clinical, Virologic, Immunologic Outcomes and Emerging HIV Drug Resistance Patterns in Children and Adolescents in Public ART Care in Zimbabwe.

OBJECTIVE: To determine immunologic, virologic outcomes and drug resistance among children and adolescents receiving care during routine programmatic implementation in a low-income country. METHODS: A cross-sectional evaluation with collection of clinical and laboratory data for children (0-<10 years) and adolescents (10-19 years) attending a public ART program in Harare providing care for pediatric patients since 2004, was conducted. Longitudinal data for each participant was obtained from the clinic based medical record. RESULTS: Data from 599 children and adolescents was evaluated. The participants presented to care with low CD4 cell count and CD4%, median baseline CD4% was lower in adolescents compared with children (11.0% vs. 15.0%, p<0.0001). The median age at ART initiation was 8.0 years (IQR 3.0, 12.0); median time on ART was 2.9 years (IQR 1.7, 4.5). On ART, median CD4% improved for all age groups but remained below 25%. Older age (≥ 5 years) at ART initiation was associated with severe stunting (HAZ <-2: 53.3% vs. 28.4%, p<0.0001). Virologic failure rate was 30.6% and associated with age at ART initiation. In children, nevirapine based ART regimen was associated with a 3-fold increased risk of failure (AOR: 3.5; 95% CI: 1.3, 9.1, p = 0.0180). Children (<10 y) on ART for ≥4 years had higher failure rates than those on ART for <4 years (39.6% vs. 23.9%, p = 0.0239). In those initiating ART as adolescents, each additional year in age above 10 years at the time of ART initiation (AOR 0.4 95%CI: 0.1, 0.9, p = 0.0324), and each additional year on ART (AOR 0.4, 95%CI 0.2, 0.9, p = 0.0379) were associated with decreased risk of virologic failure. Drug resistance was evident in 67.6% of sequenced virus isolates. CONCLUSIONS: During routine programmatic implementation of HIV care for children and adolescents, delayed age at ART initiation has long-term implications on immunologic recovery, growth and virologic outcomes.

Scaling up ART treatment capacity: lessons learned from South Africa, Zimbabwe, and Botswana.

Over the past 3 years, significant strides have been made in the effort to provide antiretroviral therapy (ART) to the millions of people worldwide who require treatment for HIV. In 2006, 1.3 million people had initiated ART in sub-Saharan Africa, which is a 10-fold increase over the number who had access to treatment 3 years prior. Although this progress should be acknowledged, achieving universal access will require much more work. As countries initiate large-scale treatment programs, many political, social, economic, and operational challenges have become evident. South Africa, Zimbabwe, and Botswana are three neighboring countries engaged in ART roll-out. This article describes the HIV epidemic in these three countries, details the most critical challenges inhibiting the progression of antiretroviral therapy roll-out, and highlights successes within each setting.

Scaling up ART treatment capacity: lessons learned from South Africa, Zimbabwe, and Botswana.

Over the past 3 years, significant strides have been made in the effort to provide antiretroviral therapy (ART) to the millions of people worldwide who require treatment for HIV. In 2006, 1.3 million people had initiated ART in sub-Saharan Africa, which is a 10-fold increase over the number who had access to treatment 3 years prior. Though this progress should be acknowledged, achieving universal access will require much more work. As countries initiate large-scale treatment programs, many political, social, economic, and operational challenges have become evident. South Africa, Zimbabwe, and Botswana are three neighboring countries engaged in ART roll-out. This paper describes the HIV epidemic in these three countries, details the most critical challenges inhibiting the progression of antiretroviral therapy roll-out, and highlights successes within each setting.