Background: Many children in rural parts of Africa are still treated with first-line antiretroviral therapy (ART) despite treatment-failure. This study wanted to see how this affected CD4 count and weight, and if these clinical parameters are sufficient to detect treatment failure. In 2009 a study was performed at Haydom Lutheran Hospital where 19 children was tested for resistant mutations. This study is a follow-up-study 12 months after.
Methods: This was a cohort study of the children from the previous study. Children <15 years of age at the previous study who had completed ≥6 months of first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART was included. CD4 count and weight were measured at routine check-ups, and registered from the children’s journal.
Results: None of the children were excluded. Data which for some reason was not available, or was registered after change to second-line treatment, was registered as “not measured”. Median age at survey was 10 years (range 5-18 years), and median duration of ART at the time of survey was 3 years (range 9 months-5 years). The reduction of CD4 count from the previous study was significant (p-value .007) for the children, who in the previous study was found to have resistant mutations, if they continued treatment with first-line ART. There was no relationship between detected resistance and weight-reduction. None of the children developed immunological failure by WHO’s definition.
Conclusion: Among children who continued treatment with first-line ART after detected resistant mutations, there is a significant reduction in CD4 count after 12 months. The reduction is not large, and other studies have shown opposite results. This shows that immunological failure and reduction in weight are insufficient for early diagnostics of treatment-failure with first-line ART.