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Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy
Background Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load i...
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| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2019
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| _version_ | 1867613220558077952 |
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| access_status_str | Open Access |
| author | Sher, Rebecca Yael Nthabiseng |
| author2 | Muloiwa, Rudzani |
| author_browse | Muloiwa, Rudzani Sher, Rebecca Yael Nthabiseng |
| author_facet | Muloiwa, Rudzani Sher, Rebecca Yael Nthabiseng |
| author_sort | Sher, Rebecca Yael Nthabiseng |
| collection | Thesis |
| description | Background
Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load in a cohort of adolescents attending an antiretroviral clinic in Cape Town, South Africa.
Methods
We conducted a retrospective cohort study of all patients on ART aged 10-19 years. Participants were included if they underwent at least two HIV viral load (VL) measurements and attended the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016. The primary outcome was two consecutive VL >100 copies/ml, in line with the lower limit of detection of assays in use over the follow-up period.
Results
Of 482 screened subjects, 327 met inclusion criteria. Most subjects were vertically infected (n= 314; 96%), and 170 (52%) were male. Overall, 203 episodes of confirmed detectable VL involving 159 (49% [95% CI 43%–54%]) subjects were experienced during the follow-up period. A total of 111 (34%) subjects never experienced detectable VL, while 16 (5%) never suppressed throughout the follow-up period. Median age at first detectable VL was 14 (IQR 11-16) years. Of the 159 subjects who experienced detectable VL, 102 (64%) re-suppressed, of which 38 (37%) had a subsequent detectable VL. Six subjects had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 subjects who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow-up time, but 42% of the follow-up time contributed by those who experienced detectable VL. The rate of detectable VL was 11.8 (95% CI 10.3–13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (RR 1.24 [95% CI 1.17-1.31]; p< 0.0001). Neither prevalence, duration nor rate of detectable VL was influenced by gender.
Conclusion
Detectable VL was seen in nearly half of adolescents, with the rate increasing with age. Viraemia was not a static process, and adolescents moved in and out of this state as adolescence progressed. Further study is warranted to correlate these findings with risks and clinical outcomes. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/29716 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:41.376Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/29716 Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy Sher, Rebecca Yael Nthabiseng Muloiwa, Rudzani Dlamini, Sipho Paediatrics Background Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load in a cohort of adolescents attending an antiretroviral clinic in Cape Town, South Africa. Methods We conducted a retrospective cohort study of all patients on ART aged 10-19 years. Participants were included if they underwent at least two HIV viral load (VL) measurements and attended the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016. The primary outcome was two consecutive VL >100 copies/ml, in line with the lower limit of detection of assays in use over the follow-up period. Results Of 482 screened subjects, 327 met inclusion criteria. Most subjects were vertically infected (n= 314; 96%), and 170 (52%) were male. Overall, 203 episodes of confirmed detectable VL involving 159 (49% [95% CI 43%–54%]) subjects were experienced during the follow-up period. A total of 111 (34%) subjects never experienced detectable VL, while 16 (5%) never suppressed throughout the follow-up period. Median age at first detectable VL was 14 (IQR 11-16) years. Of the 159 subjects who experienced detectable VL, 102 (64%) re-suppressed, of which 38 (37%) had a subsequent detectable VL. Six subjects had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 subjects who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow-up time, but 42% of the follow-up time contributed by those who experienced detectable VL. The rate of detectable VL was 11.8 (95% CI 10.3–13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (RR 1.24 [95% CI 1.17-1.31]; p< 0.0001). Neither prevalence, duration nor rate of detectable VL was influenced by gender. Conclusion Detectable VL was seen in nearly half of adolescents, with the rate increasing with age. Viraemia was not a static process, and adolescents moved in and out of this state as adolescence progressed. Further study is warranted to correlate these findings with risks and clinical outcomes. 2019-02-22T07:25:58Z 2019-02-22T07:25:58Z 2018 2019-02-22T06:23:08Z Master Thesis Masters MSc (Med) http://hdl.handle.net/11427/29716 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | Paediatrics Sher, Rebecca Yael Nthabiseng Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy |
| thesis_degree_str | Master's |
| title | Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy |
| title_full | Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy |
| title_fullStr | Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy |
| title_full_unstemmed | Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy |
| title_short | Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy |
| title_sort | patterns of detectable viral load in a cohort of hiv infected adolescents on antiretroviral therapy |
| topic | Paediatrics |
| url | http://hdl.handle.net/11427/29716 |
| work_keys_str_mv | AT sherrebeccayaelnthabiseng patternsofdetectableviralloadinacohortofhivinfectedadolescentsonantiretroviraltherapy |