Determinants of Virologic Failure and Prevalence of Resistance Mutation among HIV Infected Children on Antiretroviral Therapy at University Teaching Hospital, Lusaka, Zambia

Introduction: Viral suppression among HIV infected children is estimated at 54.3% compared to 95% UNAIDS target for viral suppression. This implies that 45.7% of children have virologic failure. An assessment of 2018 viral load results indicated a 21% cumulative incidence of virologic failure at Paediatrics Center of Excellence, University Teaching Hospital (PCOE-UTH). We aimed to investigate the determinants of virologic failure and prevalence of antiretroviral (ARV) drug resistance mutation among HIV infected children on antiretroviral therapy at PCOE-UTH, Lusaka. Methods: Retrospective cohort data was extracted from SmartCare Electronic Data Management System generated between January 2016 and December 2018, for children aged between 18 months and 14 years with valid record of viral load results at PCOE-UTH. Analytical cross sectional design was used for this study. A stepwise multivariable logistic regression was performed to identify determinants of virologic failure in children. All analyses were done using Stata software version 14.0 (Stata Corporation, College Station, Texas, USA). Results: Out of 415 participants, 91 [21.9%] had virologic failure [greater than1000 copies/ml]. Prevalence of ARV drug resistance mutation as sequelae of virologic failure was 16 [17.6%, CI: 10.4%?26.9%]. The 5 ? 9 years age group had 2.3 times the odds of developing virologic failure compared to 18 months to 4 years age group [AOR= 2.3; 95% CI 1.06?5.88; P= 0.037]. Household income greater thank3000 showed a protective effect against development of virologic failure [AOR= 0.48; 95% CI 0.23?0.99; P= 0.047]. Children on Nucleoside Reverse Transcriptase Inhibitors and Protease Inhibitor (NRTI+PI)antiretroviral combination had 2.6 times the odds of developing virologic failure compared to Nucleoside Reverse Transcriptase Inhibitor an Integrase Strand Transfer Inhibitor (NRTI+INSTI) antiretroviral combination [AOR= 2.6; 95% CI 1.27?5.14; P= 0.009]. Conclusion: Virologic failure and antiretroviral resistance mutation are still evident despite initiation of antiretroviral therapy among HIV infected children at University Teaching Hospital. Determinants such as household income, adherence to antiretroviral therapy and antiretroviral drug combination were associated with virologic failure. Assessment of children with virologic failure showed evidence of resistant mutation to Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non- Nucleoside Reverse Transcriptase Inhibitors (NNRTI). Therefore, guidelines for HIV management in children may need to address highlighted socio-economic and clinical related factors besides testing for drug sensitivity for children with antiretroviral pre-exposure before antiretroviral therapy initiation.