Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil

• Published in: Revista da Sociedade Brasileira de Medicina Tropical 2020-01, Vol.53, p.e20200333-e20200333
• Main Authors: Pacheco, Ana Luisa Opromolla, Sabidó, Meritxell, Monteiro, Wuelton Marcelo, Andrade, Solange Dourado de
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Highly active antiretroviral therapy; HIV; Major; Sustained virologic response; TROPICAL MEDICINE
• ISSN: 0037-8682; 1678-9849; 1678-9849
• DOI: 10.1590/0037-8682-0333-2020

INTRODUCTIONAchieving viral suppression (VS) in children is challenging despite the exponential increase in access to antiretroviral therapy (ART). We evaluated VS in children >1 year of age and adolescents 5 years after they had begun ART, in Manaus, Amazonas state, Brazil. METHODSHIV-infected, ART-naive children >1 year of age between 1999 and 2016 were eligible. Analysis was stratified by age at ART initiation: 1-5 y, >5-10 y, and >10-19 y. CD4+ T-cell count and viral load were assessed on arrival at the clinic, on ART initiation, and at 6 months, 1 year, 2 years, and 5 years after ART initiation. The primary outcome was a viral load 5-10 y, and 30% for >10-19 y. Almost all children (90,4%) showed an increase in CD4%+ T cell count. There were no statistically significant predictors for detecting children who do not achieve VS with treatment. VS remained below 65% in all the evaluated periods. CONCLUSIONSConsiderable immunological improvement is seen in children after ART initiation. Further efforts are needed to maintain adequate long-term VS levels and improve the survival of this vulnerable population.