HIV Viral Suppression in Children in a Subnational Antiretroviral Treatment Programme in Nigeria

Background: Despite years of Paediatric Antiretroviral therapy in Nigeria, the National implementation plan for the scale up of viral load testing was only rece ntly launched. Viral load determination is the most important indicator of ART response. Material & methods: First viral load samples were collected from 663 children living with HIV between December 2017-Decemb er 2019 aged 0 - 18 years on highly active antiretroviral therapy from 4 states within Nigeria. Samples were analyzed at a Polymerase Chain Reaction laboratory of the Federal Teaching Hospital Gombe. Results: Males were 311 (46.9%) and 352 (53.1%) female. Children aged 0 - 9 years constituted 44.9% (298); 55.1% (365) were aged 10 - 18 years. This first viral load was primarily routine in 94 .2% (625); 2.9% (19) of children respectively had suspected clinical or immunological failure. ART combination was AZT/3TC/NVP in 78.1% (518/663) of CLHIV; TDF/3TC/EFV in 21.2% (141); AZT/3TC/LPV/rtv in 4 (0.6%). Prior to initiation of routine viral load testing $0.55 (366/663) CLHI V had received HAART for 1 - 5 years; 7.8% (52/663) for 6 months but < 1 year; 32.8% (218/663) 6 - 10 years and 4.1% (27) for >10 years. The most recent CD4 count before viral load request was ≥1000/μL in 24.7% (164) of CLHIV; 500 - 999/μL in 42.9% (285); 350 - 499 μL in 11% (73) and <350 μL in 21.3% (141) of children. Viral load was ≥1000 c/ml in 51.3% (340/663) of children. Viral load was >1000 c/ml in 59.9% (174/311) males and 47.2% (166/352) females. Viral load was significantly lower among females (P-value 0.02). Of children aged 0 - 9 years 50.3% (150/298) had viral load > 1000 c/ml and 10 - 18 years 52.1% (190/365) (P value 0.660). Viral load was >1000 c/ml in 38.5% (20/52) of children on HAART for 6 months - 1 year and 52.2% (191/366) after receiving HAART for 1 - 5 years. 52.3% (114/218) and 55.6% (15/27) CLHIV had viral load > 1000 c/ml after receiving HAART for 6 - 10 and >10 years respectively (P value 0.29). Conclusion: About half of children on HAART have viral load > 1000 c/ml after more than 1 - 5 years on HAART. Longer duration of ART and use of AZT/3TC/NVP are associated with viral load > 1000 c/ml. Key considerations are poor adherence and/or viral drug resistance. Optimizing ART adherence and resistance monitoring remain key strategies for ART programmes.