title: Virologic suppression in nevirapine-exposed HIV-infected infants initiating antiretroviral therapy in rural Uganda.
abstract: We measured virologic suppression among 34 nevirapine (NVP)-exposed HIV-infected children with median age of 8.6 months (range: 3.2-19.9) initiating NVP-based antiretroviral therapy (ART) in rural Uganda. In Kaplan-Meier analysis, the cumulative probability of virologic suppression, defined as having two consecutive HIV-1 RNA <400 copies ml(-1) by 18 months was 56%. In multivariate Cox proportional hazard modeling, the following pre-ART measurements were independently associated with an increased probability of viral suppression: increasing age [hazard ratio (HR) =1.28 per 1 month increase in age, p = 0.002], lower viral load (HR = 3.54 for HIV RNA > 7 50 000 copies ml(-1), p = 0.03) and high CD4% (HR = 6.0 for CD4% > 25, p = 0.003). These results lend additional support to the 2010 World Health Organization recommendations that protease inhibitors be used to treat NVP-exposed children, but that NVP-based ART should be initiated before the decline of CD4% to optimize outcomes in NVP-exposed children when protease inhibitors are not available.
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California-San Francisco, CA 94110, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Kay
authors.forename: Humphrey
authors.initials: H
authors.lastname: Wanzira
authors.forename: Taylor
authors.initials: T
authors.lastname: Sandison
authors.forename: Abel
authors.initials: A
authors.lastname: Kakuru
authors.forename: Victor
authors.initials: V
authors.lastname: Bigira
authors.forename: Moses
authors.initials: M
authors.lastname: Kamya
authors.forename: Jaco
authors.initials: J
authors.lastname: Homsy
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Tappero
authors.forename: Diane
authors.initials: D
authors.lastname: Havlir
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
authors.forename: Theodore
authors.initials: T
authors.lastname: Ruel
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D012424:Rural Population; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D019829:Nevirapine