title: Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana.
abstract: BACKGROUND
  Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load.
  
  
  METHODS
  We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis.
  
  
  RESULTS
  Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with  ≥ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child's gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes.
  
  
  CONCLUSIONS
  First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries.
authors.affiliation: Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, CT, USA. Elijah.paintsil@yale.edu.
authors.forename: Oliver
authors.initials: O
authors.lastname: Barry
authors.forename: Jonathan
authors.initials: J
authors.lastname: Powell
authors.forename: Lorna
authors.initials: L
authors.lastname: Renner
authors.forename: Evelyn Y
authors.initials: EY
authors.lastname: Bonney
authors.forename: Meghan
authors.initials: M
authors.lastname: Prin
authors.forename: William
authors.initials: W
authors.lastname: Ampofo
authors.forename: Jonas
authors.initials: J
authors.lastname: Kusah
authors.forename: Bamenla
authors.initials: B
authors.lastname: Goka
authors.forename: Kwamena W C
authors.initials: KW
authors.lastname: Sagoe
authors.forename: Veronika
authors.initials: V
authors.lastname: Shabanova
authors.forename: Elijah
authors.initials: E
authors.lastname: Paintsil
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral; D005260:Female; D005869:Ghana; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents