Abstract:
Aim: To determine risk factors for first-line antiretroviral treatment failure in HIV-1
infected children attending Jos University Teaching Hospital, Jos.
Study Design: Retrospective cohort study.
Place and Duration of Study: Paediatric HIV clinic at the Jos University TeachingHospital, Jos, between February 2006 and December 2010.
Methodology: Data on demographic, clinical and laboratory variables for 580 HIV-1
infected children aged 2 months to 15 years on antiretroviral therapy (ART) were
analysed. A comparison of the data on children with and without treatment failure was
made. Variables associated with treatment failure in a univariate analysis were then fit in
a multivariate logistic model to determine the factors that were associated with treatment
failure.
Results: The rate of treatment failure among the children was 18.8%. Previous
antiretroviral drugs (ARV) exposure for treatment, not receiving cotrimoxazole
prophylaxis before commencement of ART and having severe immune suppression at
HIV diagnosis were the factors independently associated with treatment failure. Children
with previous ARV exposure for treatment were 4 times more likely to fail treatment
compared to those without previous exposure (AOR=4.20 (1.93-9.15); p <0.001).
Children who did not receive cotrimoxazole prophylaxis were twice more likely to
develop treatment failure compared to those who did (AOR=2.26 (1.06-4.79); p=0.03)
and children with severe immune suppression at HIV diagnosis were twice more likely to
develop treatment failure compared to those without severe immune suppression
(AOR=2.34 (1.47-3.72); p<0.001).
Conclusion: HIV-infected children with previous ARV exposure for treatment and
severe immune suppression should be monitored closely and given frequent adherence
counseling to minimize the risk of treatment failure. Cotrimoxazole prophylaxis should be
encouraged in HIV-infected children while they await commencement of ART, which may
improve ART adherence and thus reduce the risk of treatment failure.
