E.W. "Al" Thrasher
Status: Funded - Open
Optimizing antiretroviral treatment switch in HIV-infected Ugandan children
Linda Barlow-Mosha, M.D, MPH
BACKGROUND: HIV-infected children and adolescents in resource-poor settings are at increased risk of failing treatment with antiretroviral therapy (ART) and development of antiretroviral (ARV) drug resistance. HIV viral load is not readily available for monitoring ART response in resource-limited settings due to high cost.
GAP: Studies are needed to guide ART regimen switches for children and adolescents in resource-poor settings. This study provides information on the prevalence and incidence of ARV drug resistance among ART treatment-experienced Ugandan children and adolescents initiated on ART, initially without viral load monitoring.
HYPOTHESIS: We hypothesize that inclusion of viral load testing in the management of HIV-infected children receiving ART in resource-poor settings will limit antiretroviral drug resistance, preserve first-line regimens and improve response to second-line ART regimens.
METHODS: Analysis of the prevalence and extent of ARV drug resistance using plasma samples collected from 142 children and adolescents enrolled in long term follow-up of antiretroviral treatment randomized clinical trial. The prevalence and number of new resistance mutations, determined using standard and ultrasensitive genotyping assays, and number of drugs to which ARV drug resistance has developed will be determined at baseline and assessed as a function of time on ART and clinical and demographic characteristics.
IMPACT: This study will provide important information on the development of antiretroviral drug resistance in HIV-infected children initiated on ART in resource-limited settings and the benefit of including viral load monitoring. The study will also assess child survival and ARV treatment response to second-line antiretroviral regimens.
Antiretroviral, HIV, Prospective Cohort, Treatment, Human, Randomized Clinical Trial