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    Jan 17, 2021
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    Paediatric HIV Treatment Failure: A Silent Epidemic

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    Bernhelmer et al - 2015 - ...
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    Authors
    Bernheimer, Jonathan M
    Patten, Gem
    Makeleni, Thembisa
    Mantangana, Nompumelelo
    Dumile, Nombasa
    Goemaere, Eric
    Cox, Vivian
    Issue Date
    2015-07-23
    
    Metadata
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    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
    URI
    http://hdl.handle.net/10144/561279
    PubMed ID
    26208630
    Language
    en
    ISSN
    1758-2652
    Collections
    HIV/AIDS

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