Factors associated with viral suppression and rebound in children and adolescents living with HIV on antiretroviral treatment at the Bangui pediatric complex, Central African Republic
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20234106Keywords:
Bangui, Child, Rebound viral loadAbstract
Background: Suppression of viral load and its maintenance is the necessary condition for reducing mortality linked to HIV infection in children. This study aimed to investigate the factors associated with viral load rebound in children receiving antiretroviral treatment.
Methods: This was a cross-sectional study with analytical purposes, running from August 1 to 31, 2023. Were inclusive, all children living with HIV under 15 years of age, with at least two viral load results and whose parents have agreed to participate in the study.
Results: A total of 286 children were included in the study. The mean age was 11.5 years (±2.8). More than half (55.2%) of the children were not informed of their HIV status and for the majority (50.3%). Among the 198 children with a suppressed viral load at the first test, 46 (23.2%) experienced a rebound in viral load at the last test. The factors significantly associated with rebound were the low level of education of the parents (p=0.012), the administration of medicines to the children by the parents (p=0.000), the long duration of taking the medicines (p=0.021) and poor compliance with treatment (0.000).
Conclusions: The rebound in viral load after suppression is a disastrous reality for children. Efforts must be made to strengthen early therapeutic education for children, training of health workers on the process of announcing results and ongoing dialogue with children and adolescents on compliance are ways to improve the maintenance of viral suppression.
References
UNAIDS. Global AIDS Update Report 2022. Available from: https://www.unaids.org/sites/ default/files/media_asset/2022-global-aids-update_en.pdf. Accessed on 3 October 2023.
National Committee for the Fight against AIDS. National strategic plan to combat HIV and AIDS in the Central African Republic, 2023-2027. Available at: oogleusercontent.com/attachmen862permmsgid. Accessed on 3 October 2023.
Tsikhutsu I, Bii M, Dear N, Ganesan K, Kasembeli A, Sing'oei V, et al. Prevalence and correlates of viral load suppression and human immunodeficiency virus drug resistance among children and adolescents in South Rift Valley and Kisumu, Kenya. Clin Infect Dis. 2022;75(6):936-44
Chandrasekaran P, Shet A, Srinivasan R, Sanjeeva GN, Subramanyan S, Sunderesan S, Ramesh K, Gopalan B, Suresh E, Poornagangadevi N, Hanna LE. Long-term virological outcome in children receiving first-line antiretroviral therapy. AIDS Res Ther. 2018;15(1):1-10.
WHO. Key considerations for differentiated delivery of antiretroviral treatments to special populations: children, adolescents, pregnant or lactating women and key populations. Geneva: World Health Organization; 2017. Available from: https://www.who.int/publications/i/item/WHO-HIV-2017.34. Accessed on 3 October 2023.
Shiferaw MB, Endalamaw D, Hussien M, Agegne M, Amare D, Estifanos F, et al. Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia. BMC Infect Dis. 2019;19:1-6.
Muri L, Gamell A, Ntamatungiro AJ, Glass TR, Luwanda LB, Battegay M, et al. Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern. AIDS. 2017;31:61-70
Osman FT, Yizengaw MA. Virological failure and associated risk factors among pediatric HIV/AIDS patients at ART Clinic, Jimma University Medical Center, South-West Ethiopia. Open J AIDS. 2020;14:61-7.
Tsikhutsu I, Bii M, Dear N, Ganesan K, Kasembeli A, Sing’oei V, et al. Prevalence and correlates of viral load suppression and human immunodeficiency virus (HIV) drug resistance among children and adolescents in South Rift Valley and Kisumu, Kenya. Clin Infect Dis. 2022;75(6):936-44.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with Virological Failure and Suppression after Enhanced Adherence Counseling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland. PLoS One. 2015;10(2):e0116144.
Muri L, Gamell A, Ntamatungiro AJ, Glass TR, Luwanda LB, Battegay M, et al. Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern. AIDS. 2017;31:61-70
Shiferaw MB, Endalamaw D, Hussien M, Agegne M, Amare D, Estifanos F, et al. Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia. BMC Infect Dis. 2019;19:1-6.
Yelome MD. Psychological experience of orphans and vulnerable children (OVC) of HIV/AIDS at Béthesda hospital and the Cotonou social center. Available at: https://revues.acaref.net. Accessed on 3 October 2023.
Morlat P. Medical care of people living with HIV: care of children and adolescents infected with HIV. Recommendations of the expert group (February 2018). Available at: http://cns.sante.fr. Accessed on 3 October 2023.
Elizabeth Glaser Pediatric AIDS Foundation Telling a Child or Adolescent Their HIV Status- Toolkit. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2018.
Grandir. Guide to the management of HIV infection in children and adolescents, 2023. Available at: www.grandir.sidaction.org. Accessed on 3 October 2023.
Molokwane M, Madiba S. Truth, deception, and coercion; communication strategies used by caregivers of children with perinatally acquired HIV during the pre-disclosure and post-disclosure period in rural communities in South Africa. Glob Pediatr Health. 2021;8:2333794X211022269.
Opoku S, Asamoah Sakyi S, Kwame Ayisi-Boateng N, Kwame Enimil A, Senu E, Owusu Ansah R, et al. Factors associated with viral suppression and rebound among adult HIV patients on treatment: a retrospective study in Ghana. AIDS Res Ther. 2022;19:21.
Mainaa EK, Mureithia H, Adana AA, Muriukib J, Lwembeb RM, Bukusia EA. Incidences and factors associated with viral suppression or rebound among HIV patients on combination antiretroviral therapy from three counties in Kenya. Int J Infect Dis. 2020;97(1):151-8.
Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, et al. Factors associated with virological non-suppression among HIVpositive patients on antiretroviral therapy in Uganda, August 2014-July 2015. BMC Infect Dis. 2017;17(1):1-11.
O’Connor J, Smith C, Lampe FC, Johnson MA, Chadwick DR, Nelson M, et al. Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study. Lancet HIV. 2017;4(7):e295-302.
Mussa FM, Massawe HP, Bhalloo H, Moledina S, Assenga E. Magnitude and associated factors of anti-retroviral therapy adherence among children attending HIV care and treatment clinics in Dar es Salaam, Tanzania. PLoS One. 2022;17(9):e0275420.