Evaluating Second-line ART Efficacy in Pediatric HIV1 Infections: A Study at Albert Royer Children's Hospital

Abstract

Introduction: In developing countries, around 15% of children infected with the Human Immunodeficiency Virus (HIV) have access to early diagnosis, and 28% are eligible for antiretroviral treatment (ART). The evaluation studies carried out in Senegal have been limited to children on first-line ART. The main objective of our study was to evaluate the efficacy of second-line ART. Methodology: Data were collected at 3 different sites. This was a retrospective, longitudinal and analytical study, conducted from March 4 to August 28, 2015. The study population consisted of 65 HIV1-infected children. BD FACSCountTM Flow Cytometer for TCD4 lymphocyte counting. For genotyping, 2 sets of PCRs were required. Data were entered and analysed using Word/Excel 2013 and Epi-info7 software. Results: We had 43 boys and 22 girls, giving a sex ratio of 1.95. The extreme ages were 5 and 15 years, and the mean age was 11.43 years. The majority belonged to stage 4 and 2 of the WHO classification. The clinical evolution was favourable in 86.15%, unfavourable in 3.07% and unspecified in 10.76%. We found 9 genotypes and recombinant forms; 80% of the strains were sequenced. Discussion: The general aim of ART is the same as in adults. Clinical stages were not specified in 15.38% of cases. In total, 58.46% had an excellent immunovirological response. We conclude from this that a good IR doesn’t mean a good immunovirological evolution. Initiation of ART should be guided by genotyping. Conclusion-Recommendations: ART reduced morbidity and mortality. Our study showed a virological failure rate of 21.53% and an IR rate of 86.15%.