TITLE:
HIV Viral Suppression in Children in a Subnational Antiretroviral Treatment Programme in Nigeria
AUTHORS:
Elon Warnow Isaac, Ayomikun Ajani, Jalo Iliya, Oyeniyi Christianah, Danlami Mohammed Hassan
KEYWORDS:
Children, ART, Viral Load > 1000 c/ml, Nigeria
JOURNAL NAME:
World Journal of AIDS,
Vol.10 No.3,
September
16,
2020
ABSTRACT: Background: Despite years of Paediatric Antiretroviral therapy in Nigeria, the
National implementation plan for the scale up of viral load testing was only
rece ntly launched. Viral load determination
is the most important indicator of ART response. Material & methods: First viral load samples were collected from 663 children living with HIV
between December 2017-Decemb er 2019 aged 0 - 18 years
on highly active antiretroviral therapy from 4 states within Nigeria. Samples
were analyzed at a Polymerase Chain Reaction laboratory of the Federal Teaching
Hospital Gombe. Results: Males were 311 (46.9%) and 352 (53.1%) female.
Children aged 0 - 9 years constituted 44.9% (298); 55.1% (365) were aged 10 - 18 years.
This first viral load was primarily routine in 94 .2% (625); 2.9% (19) of children respectively had suspected clinical or
immunological failure. ART combination was AZT/3TC/NVP in 78.1% (518/663) of
CLHIV; TDF/3TC/EFV in 21.2% (141); AZT/3TC/LPV/rtv in 4 (0.6%). Prior to initiation of routine viral load testing $0.55
(366/663) CLHI V had received HAART for 1 - 5 years;
7.8% (52/663) for 6 months but 10 years. The most
recent CD4 count before viral load request was ≥1000/μL in
24.7% (164) of CLHIV; 500 - 999/μL in 42.9% (285); 350 - 499 μL
in 11% (73) and 1000 c/ml in
59.9% (174/311) males and 47.2% (166/352) females. Viral
load was significantly lower among females (P-value 0.02). Of children aged 0 - 9 years
50.3% (150/298) had viral load > 1000 c/ml
and 10 - 18 years 52.1% (190/365) (P value 0.660). Viral load was >1000 c/ml in
38.5% (20/52) of children on HAART for 6 months - 1 year
and 52.2% (191/366) after receiving HAART for 1 - 5 years.
52.3% (114/218) and 55.6% (15/27) CLHIV had viral load > 1000 c/ml
after receiving HAART for 6 - 10 and >10 years respectively (P value 0.29). Conclusion: About half of
children on HAART have viral load > 1000 c/ml
after more than 1 - 5 years on HAART. Longer duration of ART and use of AZT/3TC/NVP are
associated with viral load > 1000 c/ml.
Key considerations are poor adherence and/or viral drug resistance. Optimizing
ART adherence and resistance monitoring remain key strategies for ART
programmes.