Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Elijah Paintsil

Subject Area(s)

Medicine

Abstract

Title: EFFECTIVENESS AND MONITORING OFANTIRETROVIRAL THERAPY FOR HIV- INFECTED CHILDREN IN ACCRA, GHANA

Authors: Oliver M. Barry, Meghan Prin, Lorna A. Renner, Bamenla Goka, Jonas Kusah, Kwamena W. Sagoe, and Elijah Paintsil. Section of Infectious Diseases, Department of Pediatrics, Yale University, School of Medicine, New Haven, CT.

Despite advances in HIV diagnosis and care, many challenges remain in resource-limited settings. As scale-up of antiretroviral therapy (ART) progresses in resource-limited settings, evaluation of available first-line regimens and monitoring techniques is needed to ensure the safety and success of such efforts. This study had two specific aims. First, the study aimed to evaluate the effectiveness of first-line ART regimens at a large HIV program in Ghana where participants are predominantly infected with non-type B HIV virus. Second, the study aimed to investigate the potential value of laboratory-based biomarkers, specifically absolute CD4 cell count, CD4 cell percentage and HIV RNA viral load in predicting failure on ART. This study enrolled a prospective cohort of 87 HIV-infected children receiving care at Korle Bu Teaching Hospital in Accra, Ghana. Blood samples were collected a 4-6 month intervals and participants were followed until treatment failure, defined by WHO criteria, as the primary study outcome. 83% of participants demonstrated effective treatment response to first-line regimens with 0% associated mortality and only 4.7% switched regimens over the study period. Predictors of treatment failure included a shorter time interval between HIV diagnosis and ART initiation (p=0.014) and parents who are both HIV-positive (p=0.05). Lower mean baseline absolute CD4 cell count appears to be a significantly predictor for immunological failure (p=0.041). Absolute CD4 cell count and CD4 cell percentage after ART initiation showed similar trajectories and patterns. The findings demonstrated that available first-line ART regimens were effective, well tolerated and potentially durable in this setting with little evidence of resistance or toxicity. In settings in which CD4 cell percentage is not readily available, absolute CD4 cell count may provide an alternative biomarker for monitoring treatment response. These conclusions hold valuable public health implications in the scale-up of ART access and monitoring.

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