Paediatric HIV Treatment Failure: A Silent Epidemic

Hdl Handle:
http://hdl.handle.net/10144/561279
Title:
Paediatric HIV Treatment Failure: A Silent Epidemic
Authors:
Bernheimer, Jonathan M; Patten, Gem; Makeleni, Thembisa; Mantangana, Nompumelelo; Dumile, Nombasa; Goemaere, Eric; Cox, Vivian
Journal:
Journal of the International AIDS Society
Abstract:
Paediatric antiretroviral treatment (ART) failure is an under-recognized issue that receives inadequate attention in the field of paediatrics and within HIV treatment programmes. With paediatric ART failure rates ranging from 19.3% to over 32% in resource limited settings, a comprehensive evaluation of the causes of failure along with approaches to address barriers to treatment adherence are urgently needed. In partnership with the local Department of Health, a pilot programme has been established by Medecins Sans Frontieres (MSF) in Khayelitsha, South Africa, to identify and support paediatric HIV patients with high viral loads and potential treatment failure. Through detailed clinical and psychosocial evaluations and adherence support with an innovative counselling model, treatment barriers are identified and addressed. Demographic and clinical characteristics from the cohort show a delayed median start date for ART, prolonged viraemia including a large number of patients who have never achieved viral load (VL) suppression, a low rate of regimen changes despite failure, and a high percentage of pre-adolescent and adolescent patients who have not gone through the disclosure process. Stemming this epidemic of paediatric treatment failure requires programmatic responses to high viral loads in children, starting with improved "case finding" of previously undiagnosed HIV-infected children and adolescents. Viral load testing needs to be prioritized over CD4 count monitoring, and flagging systems to identify high VL results should be developed in clinics. Clinicians must understand that successful treatment begins with good adherence, and that simple adherence support strategies can often dramatically improve adherence. Moreover, appropriate adherence counselling should begin not when the child fails to respond to treatment. Establishing good adherence from the beginning of treatment, and supporting ongoing adherence during the milestones in these children's lives is key to sustaining treatment success in this vulnerable HIV-infected patient population.
Publisher:
International AIDS Society
Issue Date:
23-Jul-2015
URI:
http://hdl.handle.net/10144/561279
PubMed ID:
26208630
Language:
en
ISSN:
1758-2652
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorBernheimer, Jonathan Men_GB
dc.contributor.authorPatten, Gemen_GB
dc.contributor.authorMakeleni, Thembisaen_GB
dc.contributor.authorMantangana, Nompumeleloen_GB
dc.contributor.authorDumile, Nombasaen_GB
dc.contributor.authorGoemaere, Ericen_GB
dc.contributor.authorCox, Vivianen_GB
dc.date.accessioned2015-07-30T14:25:01Z-
dc.date.available2015-07-30T14:25:01Z-
dc.date.issued2015-07-23-
dc.identifier.citationPaediatric HIV treatment failure: a silent epidemic. 2015, 18 (1):20090 J Int AIDS Socen_GB
dc.identifier.issn1758-2652-
dc.identifier.pmid26208630-
dc.identifier.urihttp://hdl.handle.net/10144/561279-
dc.description.abstractPaediatric antiretroviral treatment (ART) failure is an under-recognized issue that receives inadequate attention in the field of paediatrics and within HIV treatment programmes. With paediatric ART failure rates ranging from 19.3% to over 32% in resource limited settings, a comprehensive evaluation of the causes of failure along with approaches to address barriers to treatment adherence are urgently needed. In partnership with the local Department of Health, a pilot programme has been established by Medecins Sans Frontieres (MSF) in Khayelitsha, South Africa, to identify and support paediatric HIV patients with high viral loads and potential treatment failure. Through detailed clinical and psychosocial evaluations and adherence support with an innovative counselling model, treatment barriers are identified and addressed. Demographic and clinical characteristics from the cohort show a delayed median start date for ART, prolonged viraemia including a large number of patients who have never achieved viral load (VL) suppression, a low rate of regimen changes despite failure, and a high percentage of pre-adolescent and adolescent patients who have not gone through the disclosure process. Stemming this epidemic of paediatric treatment failure requires programmatic responses to high viral loads in children, starting with improved "case finding" of previously undiagnosed HIV-infected children and adolescents. Viral load testing needs to be prioritized over CD4 count monitoring, and flagging systems to identify high VL results should be developed in clinics. Clinicians must understand that successful treatment begins with good adherence, and that simple adherence support strategies can often dramatically improve adherence. Moreover, appropriate adherence counselling should begin not when the child fails to respond to treatment. Establishing good adherence from the beginning of treatment, and supporting ongoing adherence during the milestones in these children's lives is key to sustaining treatment success in this vulnerable HIV-infected patient population.en_GB
dc.language.isoenen
dc.publisherInternational AIDS Societyen_GB
dc.rightsArchived with thanks to Journal of the International AIDS Societyen_GB
dc.titlePaediatric HIV Treatment Failure: A Silent Epidemicen
dc.identifier.journalJournal of the International AIDS Societyen_GB

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