Virological response to first-line antiretroviral therapy among HIV-Infected children attending a large care programme in Western Kenya

Abstract

Background :Approximately 36.7 million people are living with Human Immunodeficiency Virus (HIV) with 1.8 million being children. More than 90% of these are living in Sub-Saharan Africa. The World Health Organization’s (WHO) plan to achieve 90% antiretroviral therapy (ART) coverage with 90% virological suppression by 2020 can only be achieved by proper monitoring of treatment response which will help in the early detection of failing regimen and prevention of drug resistance development. WHO now recommends virological monitoring since clinical and immunological criteria used previously had low sensitivity. This study sought to find out the proportion of children who achieved virological suppression and the determinant factors. Objectives: To describe virological response to ART among children attending Academic Model Providing Access to Health (AMPATH) clinics in Western Kenya. Methods: This was a retrospective chart review of routinely collected data conducted between June 2014 and July 2016 at three AMPATH clinics. Consecutive sampling was used to recruit HIV-infected children according to selection criteria. Socio-demographic and clinical data was collected using a pretested data collection tool. Data was entered in Microsoft Access and exported to STATA version 13 for analysis. Descriptive statistics such as frequency listings were used for categorical variables, while Chi square test and Fischer’s exact test were used to assess associations. Multiple logistic regression was used to determine independent variables. All analysis was done at 95% level of significance with p-value less than 0.05 being statistically significant. Results: Of the 371 study participants, 194(52.50%) were males. The median age at ART initiation was 84 months (IQR 36-123) with only 47(12.70%) having used nevirapine for prevention of mother to child transmission (PMTCT) of HIV. Most of the children (98.9%) had good adherence (≥95%). Majority of the children (96%) did not develop opportunistic infections. Opportunistic infections reported included tuberculosis (0.35%) and herpes (0.14%). Majority of the children had WHO stage 1(49.30%) and WHO stage 2 (24.50%) disease with most of them having used ART for six to twelve months (73.29%). Most of the children had normal nutritional status (62.90%) and only (27.10%) and (10.00%) had undernutrition and overweight, respectively. After at least six months of ART, 78.44% (95%CI: 73.90,82.51) of children achieved virological suppression, at a median time to virological suppression of 10.84 months (95% CI: 9.72,11.93). Of the socio-demographic and clinical factors affecting virological suppression, only age at ART initiation was statistically significant (p=0.037). Conclusions: Slightly more than three-quarters of children achieved virological suppression following at least six months of first-line ART, with majority of the children reported to have good adherence. Younger children at ART initiation were more likely to achieve virological suppression compared with older children. Recommendations: Efforts to be made at all levels of care provision to enhance earlier initiation of ART in all HIV-infected children.