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Virological efficacy and immunological recovery among Ethiopian HIV-1 infected adults and children
- Source :
- BMC Infectious Diseases
- Publisher :
- Springer Nature
-
Abstract
- Background Introduction of antiretroviral therapy (ART) in sub-Saharan Africa was a hot debate due to many concerns about adherence, logistics and resistance. Currently, it has been significantly scaled up. However as the WHO clinico-immunological approaches for initiation and monitoring of ART in the region lacks viral load determination and drug resistance monitoring, HIV infected adults and children may be at risk for “unrecognized” virologic failure and the subsequent development of antiretroviral drug resistance. This study evaluates the virological efficacy and immunological recovery of HIV/AIDS patients under ART. Methods Consecutive HIV-1 infected adults (N = 100) and children (N = 100) who have been receiving ART for up to 6 years at Gondar University Hospital, Ethiopia were enrolled following the WHO protocol for assessment of acquired drug resistance. Magnitude of viral suppression, genotypic drug resistance mutations and patterns of CD4+ T cell recovery were determined using standard virological and immunological methods. Results Virological suppression (HIV RNA < 40 copies/ml) was observed in 82 and 87% of adults and children on a median time of 24 months on ART, respectively. Mutation K103N conferring resistance to non nucleoside reverse transcriptase inhibitors and thymidine analogue mutations (M41L, L210W) were found only in one adult and child patient, respectively. Median CD4+ T cell count has increased from baseline 124 to 266 (IQR: 203–306) and 345 (IQR: 17–1435) to 998 (IQR: 678–2205) cells/mm3 in adults and children respectively after 12 months of ART. Nevertheless, small but significant number of clinically asymptomatic adults (16%) and children (13%) had low level viraemia (HIV-1 RNA 41–1000 copies/ml). Conclusions Majority of both adults (82%) and children (87%) who received ART showed high viral suppression and immunological recovery. This indicates that despite limited resources in the setting virological efficacy can be sustained for a substantial length of time and also enhance immunological recovery irrespective of age. However, the presence of drug resistance mutations and low level viraemia among clinically asymptomatic patients highlights the need for virological monitoring.
- Subjects :
- Adult
CD4-Positive T-Lymphocytes
Male
medicine.medical_specialty
Genotype
T cell
CD4 T cells
HIV Infections
Drug resistance
Asymptomatic
HIV viral load
Medical microbiology
Internal medicine
HIV drug resistance
Drug Resistance, Viral
Humans
Medicine
Longitudinal Studies
Viremia
Child
business.industry
Middle Aged
Viral Load
Antiretroviral
CD4 Lymphocyte Count
medicine.anatomical_structure
Infectious Diseases
Anti-Retroviral Agents
Parasitology
Child, Preschool
Mutation
Immunology
HIV-1
Reverse Transcriptase Inhibitors
Female
Ethiopia
medicine.symptom
business
Viral load
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712334
- Volume :
- 14
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Infectious Diseases
- Accession number :
- edsair.doi.dedup.....872db6a95599a51593babd4d953694b4
- Full Text :
- https://doi.org/10.1186/1471-2334-14-28