Open Access Highly Accessed Research article

Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana

Oliver Barry1, Jonathan Powell2, Lorna Renner3, Evelyn Y Bonney4, Meghan Prin1, William Ampofo4, Jonas Kusah3, Bamenla Goka3, Kwamena WC Sagoe3, Veronika Shabanova5 and Elijah Paintsil6*

Author Affiliations

1 From the Columbia University, New York, NY, USA

2 Weill Cornell Medical College, New York, NY, USA

3 University of Ghana Medical School, Accra, Ghana

4 Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana

5 Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, CT, USA

6 Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, CT, USA

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BMC Infectious Diseases 2013, 13:476  doi:10.1186/1471-2334-13-476

Published: 13 October 2013



Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load.


We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis.


Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with ≥ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child’s gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes.


First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries.

Pediatrics; Antiretroviral therapy; Laboratory monitoring; Virologic failure; HIV drug resistance mutations