Rural Tanzania study cites multiple failures in treatment of pediatric HIV patients

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” . . . after a decade of successful rollout of [antiretroviral treatment] in Africa, children and adolescents still represent an underprivileged population.”

A study examining the effectiveness of treatment for HIV among children and adolescents in Tanzania found gaps in meeting their needs that led to acquired resistance to available drugs. The study, reported in a recent Open Forum Infectious Diseases, focused on 12 children showing signs of treatment failure at an HIV treatment clinic in rural Tanzania.

Ten of the 12 children had been born before 2006, the year efforts to prevent mother to child transmission of HIV began in earnest in Tanzania. The age at which the children had started treatment for HIV ranged from seven months, to 13 years, with the median age about 6 and a half. Ten of the children were orphans, having lost one or both parents. While none of the children had been identified through a program to prevent mother to child HIV transmission, and none were known to have been exposed to antiretroviral treatment to prevent transmission from their mothers, by the time  their treatment was tracked for the study, seven of the children had been exposed to more than one first-line antiretroviral treatment regimen, three having been switched back and forth more than once. Those changes, researchers found, were made mostly because the drugs the children were receiving became unavailable. Researchers also found that of the 10 children for whom information on prescribed doses was available, seven had received less medicine than the dose considered necessary for as long as three years, because doses were not adjusted for children’s growth.

Of the 12 children, 11 now lived with viruses that had become resistant to antiretroviral drugs. Information available on nine of the patients who had been enrolled for treatment upon diagnoses showed that their viruses had not been resistant to treatment when they were diagnosed. The virus of a now 17-year-old patient whose viral load had only continued to increase showed no sign of drug-resistant changes, indicating that treatment was failing because of low adherence.

While the authors acknowledge the study focused on a small population, the findings highlight the need for more, and appropriate antiretroviral treatment regimens for children, attention to adherence strategies for adolescents, the need for raised awareness among health workers of adequate dosing for growing patients, and the need for routine viral load monitoring in children.

“In conclusion,” they write, “after a decade of successful rollout of ART in Africa, children and adolescents still represent an underprivileged population.”

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