title: Prevalence and determinants of virological failure in HIV-infected children on antiretroviral therapy in rural Cameroon: a cross-sectional study.
abstract: BACKGROUND
  In Africa, success of antiretroviral treatment (ART) seems to lag behind in children compared with adults, and high therapeutic failure rates have been reported. We aimed to identify prevalence and determinants of virological failure in HIV-infected children treated under programmatic conditions.
  
  
  METHODS
  All patients <18 years on ART presenting to the HIV clinic at the Bamenda Regional Hospital, a secondary referral hospital in rural Cameroon, from September 2010 to August 2011, were enrolled in this cross-sectional study. Clinical data, self-reported adherence, CD4(+) T-cell counts and viral load were recorded. Therapeutic drug monitoring was performed on stored plasma samples. Determinants of virological failure were identified using descriptive statistics and logistic regression.
  
  
  RESULTS
  A total of 230 children with a mean age of 8.9 years (sd 3.7) were included. At the time of analysis, the mean duration of HAART was 3.5 years (sd 1.7) and 12% had a CD4(+) T-cell count <200 cells/µl. In total, 53% of children experienced virological failure (>200 copies/ml). Among children on nevirapine (NVP), plasma levels were subtherapeutic in 14.2% and supratherapeutic in 42.2%. Determinants of virological failure included male sex, lower CD4(+) T-cell counts, subtherapeutic drug levels, longer time on ART and a deceased mother. Poor adherence was associated with subtherapeutic NVP plasma levels and advanced disease stages (WHO stage 3/4).
  
  
  CONCLUSIONS
  This study demonstrates high virological failure rates and a high variability of NVP plasma levels among HIV-infected children in a routine ART programme in rural Cameroon. Strategies to improve adherence to ART in HIV-infected children are urgently needed.
authors.affiliation: Department of Medicine I, Infectious Diseases Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. a.zoufaly@uke.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zoufaly
authors.forename: Quirine
authors.initials: Q
authors.lastname: Fillekes
authors.forename: Raffaela
authors.initials: R
authors.lastname: Hammerl
authors.forename: Nilofar
authors.initials: N
authors.lastname: Nassimi
authors.forename: Johannes
authors.initials: J
authors.lastname: Jochum
authors.forename: Jan F
authors.initials: JF
authors.lastname: Drexler
authors.forename: Charles N
authors.initials: CN
authors.lastname: Awasom
authors.forename: Frida
authors.initials: F
authors.lastname: Sunjoh
authors.forename: Gerd D
authors.initials: GD
authors.lastname: Burchard
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
authors.forename: Jan
authors.initials: J
authors.lastname: van Lunzen
authors.forename: Torsten
authors.initials: T
authors.lastname: Feldt
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055118:Medication Adherence; D015995:Prevalence; D012424:Rural Population; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents