Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil
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: H...
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ftdoajarticles:oai:doaj.org/article:bfd77799526840db9d83963ca6ff4fcc 2023-05-15T15:12:06+02:00 Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil Ana Luisa Opromolla Pacheco Meritxell Sabidó Wuelton Marcelo Monteiro Solange Dourado de Andrade 2020-10-01T00:00:00Z https://doi.org/10.1590/0037-8682-0333-2020 https://doaj.org/article/bfd77799526840db9d83963ca6ff4fcc EN eng Sociedade Brasileira de Medicina Tropical (SBMT) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100364&tlng=en https://doaj.org/toc/1678-9849 1678-9849 doi:10.1590/0037-8682-0333-2020 https://doaj.org/article/bfd77799526840db9d83963ca6ff4fcc Revista da Sociedade Brasileira de Medicina Tropical, Vol 53 (2020) Highly active antiretroviral therapy Child Adolescent HIV Sustained virologic response Arctic medicine. Tropical medicine RC955-962 article 2020 ftdoajarticles https://doi.org/10.1590/0037-8682-0333-2020 2022-12-31T02:52:39Z 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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Revista da Sociedade Brasileira de Medicina Tropical 53 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Highly active antiretroviral therapy Child Adolescent HIV Sustained virologic response Arctic medicine. Tropical medicine RC955-962 |
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Highly active antiretroviral therapy Child Adolescent HIV Sustained virologic response Arctic medicine. Tropical medicine RC955-962 Ana Luisa Opromolla Pacheco Meritxell Sabidó Wuelton Marcelo Monteiro Solange Dourado de Andrade Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil |
topic_facet |
Highly active antiretroviral therapy Child Adolescent HIV Sustained virologic response Arctic medicine. Tropical medicine RC955-962 |
description |
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. |
format |
Article in Journal/Newspaper |
author |
Ana Luisa Opromolla Pacheco Meritxell Sabidó Wuelton Marcelo Monteiro Solange Dourado de Andrade |
author_facet |
Ana Luisa Opromolla Pacheco Meritxell Sabidó Wuelton Marcelo Monteiro Solange Dourado de Andrade |
author_sort |
Ana Luisa Opromolla Pacheco |
title |
Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil |
title_short |
Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil |
title_full |
Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil |
title_fullStr |
Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil |
title_full_unstemmed |
Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil |
title_sort |
unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the amazonas state, brazil |
publisher |
Sociedade Brasileira de Medicina Tropical (SBMT) |
publishDate |
2020 |
url |
https://doi.org/10.1590/0037-8682-0333-2020 https://doaj.org/article/bfd77799526840db9d83963ca6ff4fcc |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista da Sociedade Brasileira de Medicina Tropical, Vol 53 (2020) |
op_relation |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100364&tlng=en https://doaj.org/toc/1678-9849 1678-9849 doi:10.1590/0037-8682-0333-2020 https://doaj.org/article/bfd77799526840db9d83963ca6ff4fcc |
op_doi |
https://doi.org/10.1590/0037-8682-0333-2020 |
container_title |
Revista da Sociedade Brasileira de Medicina Tropical |
container_volume |
53 |
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1766342832517283840 |