Background: Early recognition of antiretroviral therapy (ART) failure in resource limited settings is a challenge given\r\nthe limited laboratory facilities and trained personnel. This study aimed at describing the incidence, risk factors and\r\nthe resistance associated mutations (RAMs) of first line treatment failure among HIV-1-infected children attending\r\nthe Joint Clinical Research Centre (JCRC), Kampala, Uganda.\r\nMethods: A retrospective cohort of 701 children who had been initiated on ART between January 2004 and\r\nSeptember 2009 at the JCRC was studied. Data of children aged 6 months up to 18 years who had been started on\r\nART for at least 6 months was extracted from the clinic charts. The children who failed the first-line ART were taken\r\nas cases and those who did not fail as the controls. Data was analysed using STATA version10.\r\nResults: Of 701 children, 240(34%) failed on first line ART (cases) and 461(66%) did not fail (controls). The overall\r\nmedian time (IQR) to first line ART failure was 26.4 (18.9 ââ?¬â?? 39.1) months. The factors associated with treatment\r\nfailure were poor adherence [(OR = 10, 95 CI: 6.4 ââ?¬â?? 16.7) p < 0.001], exposure to single dose nevirapine (sdNVP)\r\n[(OR = 4.2, 95% CI:1.8-9.4), p = 0.005] and a NVP containing regimen [(OR = 2.2,95% CI:1.4-3.6), p < 0.001]. Of 109\r\ngenotypic resistance profiles analyzed, the commonest non nucleoside reverse transcriptase inhibitor (NNRTI) resistance\r\nassociated mutations (RAM) were: K103N (59; 54%)), Y181C (36; 27%)) and G190A (26; 24%)) while the commonest\r\nnucleoside reverse transcriptase inhibitor (NRTI) RAM was the M184V (89; 81%). Thymidine analogue- mutations\r\n(TAMs) were detected in 20% of patients.\r\nConclusions: One in three children on first-line ART are likely to develop virological treatment failure after the first\r\n24 months of therapy. Poor adherence to ART, a NVP based first-line regimen, prior exposure to sdNVP were\r\nassociated with treatment failure.
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