Outcomes of protease inhibitor-based antiretroviral therapy amongst children and associated-factors in Yaoundé, Cameroon

• Published in: PloS one Vol. 14; no. 3; p. e0213900
• Main Authors: Njom Nlend, Anne Esther, Guessong, Cathya Ornella, Nga Motaze, Annie Carole, Soffo, Claudian, Koki Ndombo, Paul Olivier, Tsambang, Lionel, Fokam, Joseph
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.03.2019; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adolescents; Age; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Cameroon; CD4 antigen; CD4 Lymphocyte Count; Child; Child, Preschool; Children; Cohort Studies; Drug resistance; Female; HIV; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV Protease Inhibitors - therapeutic use; Human immunodeficiency virus; Humans; Immunology; Male; Medicine and Health Sciences; Multivariate Analysis; Outcome Assessment, Health Care; Parents; Pediatrics; People and Places; Physical Sciences; Protease; Protease inhibitors; Proteinase inhibitors; Research and Analysis Methods; Retrospective Studies; Statistical analysis; Substitutes; Therapy; Treatment Failure; Viral Load - drug effects; Cameroon; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0213900

There are limited data on protease inhibitor (PI)-based antiretroviral therapy (ART) amongst children in resource-limited settings, for informing on optimal paediatric regimens. To evaluate therapeutic response to PI-based ART amongst HIV-infected Cameroonian children. A retrospective study was conducted amongst children aged 2-18 years receiving a PI-based ART at the Essos Hospital Centre (EHC), Yaounde, Cameroon. Primary end points were therapeutic success on PI-based ART, defined as clinical success (WHO I/II clinical stage), immunological success (CD4 ≥ 500/mm3) and viral suppression (viral load [VL]<1000 copies/ml). Factors associated with therapeutic success were assessed in uni- and multivariate analysis using SPSS software v.2.0; with p<0.05 considered statistically significant. A total of 71 eligible children on PI-based ART were enrolled (42 on initial and 29 on substituted regimens), with a median age of 8 [IQR: 5-12] years and mean duration on ART of 7 years. Following therapeutic responses, all (100%) experienced clinical success, 95.2% experienced immunological success (91.7% on initial and 97.2% on substituted PI/r-based regimens) and 74.7% viral suppression. In univariate analysis, viral suppression was associated with: younger age (p<0.0001), living with parents as opposed to guardians (p = 0.049), and the educational level (p<0.0001). In multivariate analysis, only the age ranges of 10-14 years (OR: 0.22 [0.07-0.73]) and 15-18 years (OR: 0.08 [0.02-0.57]), were determinants of poor viral suppression. Among these Cameroonian children, PI-based ART confers favourable clinical and immunological outcomes. The poor rate of viral suppression was mainly attributed to adolescence (10-18 years).