Clinico-demographic Profile and Treatment Outcomes of Pediatric Participants of a Large Outpatient HIV Clinic in Kigali, Rwanda
Pediatric patients make up 7.5% of the global population living with HIV infection and comprise 15% of incident cases worldwide each year (WHO). 91% of the 3.4 million children living with HIV at the end of 2011 reside in sub-Saharan Africa (WHO). They represent a challenging population to manage due to limited pediatric ARV formulations, poor healthcare resources, suboptimal medication adherence, societal stigma and neglect. Data on the demographics, clinical profile, and treatment outcomes of the pediatric HIV population is lacking in Rwanda.
Study was a retrospective chart review conducted from February 1, 2013 – January 31, 2014. The aim was to describe the demographics, clinical characteristics, and treatment outcomes of HIV infected pediatric participants (age <18 years) of a large outpatient HIV clinic in Kigali, Rwanda. Charts for review were selected by simple random sampling. Categorical demographic data and other categorical variables were expressed as simple frequencies and/or percentages of the whole. Continuous variables were expressed as median values with inter-quartile ranges or means with ranges as appropriate.
174 randomly selected charts were reviewed including 84 males and 90 females (sex distribution 1:1.1). Median age and CD4 count at the time of HIV diagnosis was 6 years (IQR 3-9 years) and 380 cells/uL (IQR 206-662 cells/uL) respectively. Nadir CD4 count was 272 cells/uL (IQR 148-416 cells/uL). Vertical transmission was the predominant mode of acquisition of HIV infection (70%). 46 out of 161 patients (28.6%) had WHO clinical stage 3 or 4 HIV disease at time of initial presentation to care. 68.2%, 27.2% and 4.6% of patients were on nevirapine (NVP), efavirenz(EFV) and lopinavir/ritonavir based regimens respectively. Average duration of ARV exposure was 83 months (range 8-135 months). 61/162 patients (37.7%) had HIV viral loads >400 copies/ml during their most recent viral load estimation.
Pediatric participants of the largest outpatient HIV clinic in Kigali, Rwanda frequently present late to care with advanced HIV disease and experience significant rates of virologic failure. More studies are needed to explore the causes of these observations.
J. L. Nkurikiyimfura, None
O. Manzi, None
O. Ogbuagu, None
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