Abstract Ref Number = APCP761
First Line Antiretroviral Treatment Failure Cases in Pediatric HIV at Harapan Kita Women and Children Hospital
Dwinanda Aidina Fitrani, Amar Widhiani, Endah Citraresmi, Nurul Iman Nilam Sari
Pediatric Infectious and Tropical Diseases Division, Allergy and Immunology Division,
Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta
Background: Antiretroviral (ARV) treatment failure can be serious issue in pediatric HIV management in Indonesia. In resource-limited settings, rates of ARV treatment failure are ranging from 19.3% to over 32%.The causes of ARV treatment failure include poor adherence, drug resistance, poor absorption of medications, inadequate dosage, and drug-to-drug interactions. Clinicians should pay attention to thisissue because there are limited choices of ARV in Indonesia.
Methods: Samples included were pediatric HIV patients at Harapan Kita Women and Children Hospital who failed on first line ARV at Harapan Kita Women and Children Hospital Jakarta between year 2010 and 2017. We assessed clinical, virologic, and immunologic treatment failure or combination of them. Adherence was assessed from patients’ self-reports.
Results: Twelve of 73 patients (16%) were diagnosed as first line ARV treatment failure. Age range was 10 months to 7 years as first diagnosed HIV infection. Seven patients had severe immunosuppresion at ARV initiation, 3 patients with mild immunosuppresion, and 2 patients with no immunosupression. Four patients had tuberculosis infection and treated with antituberculosis drugs. Six patients underwent immunologic failure, 5 patients had immunologic and virologic failure, 1 patient had combination of clinical, virologic, and immunologic failure. Five patients were diagnosed as treatment failure within 2 years after initiating ARV. Seven patients achieved viral suppresion after changing to second line ARV, while the others had not been evaluated yet. One patient died due to virologic and immunologic failure. Only 2 patients had bad adherence.
Conclusion: Multifactors can cause ARV treatment failure in our clinical setting. Limitation including lack of modalities to evaluate drug plasma level, lack of CD4 and viral load monitoring, and inadequate adherence counselling should be managed comprehensively to prevent treatment failure. Further studies are needed in larger population for better assessment of ARV treatment failure in Indonesia.
Keywords: pediatric HIV ARV treatment failure