The first ever national HIV treatment assessment in Kenya shows high failure rates in children and adolescents. The report has got medical experts worried, especially because a lot of infections occur at young age. Ideally anti-HIV drugs called antiretrovirals (ARVs) should suppress the amount of viruses in the body, called viral load, (VL) to undetectable levels within six months of use.
However, an analysis of viral suppression in Kenya from 2012 to 2016 shows huge failures among children and young men.
Elevated viral loads
For example, the audit shows 43 per cent of children under three and 34.5 per cent of those under 10 had elevated viral loads. In this case, elevated viral load was categorised as a patient having more than 1000 copies/mL, a situation which should prompt medical follow-up. Chances that a child under three had uncontrolled HIV was nearly five times that in adults.
The audit by the Kenya Medical Research Institute (Kemri) and the National Aids and STI Control Programme (Nascop) appeared in the Journal Plos One on January 11.
Thirty six per cent of adolescents aged 10-20 had elevated viral load with 13.3 per cent of adults having their HIV uncontrolled. Among the adults, men were more likely than women to have elevated viral loads.
Lead author, Dr Matilu Mwau of Kemri explained that children generally have more viruses compared to adults mainly due to poorly developed defence systems.But also giving medicines to children has its unique problems including tablets size, taste and palatability. “It is the youth we are most worried about because this is where most new HIV infections are occurring today,” says Dr Chritine Sadia, chairperson Kenya Women Medical Association.
The study says adolescents and the youth are not taking their medicines as required for various reasons including fear of stigma.
“We need to prioritise care for this population,” says Dr Sadia.
Even among the general male population where viral suppression was less than in women HIV control was worst in youthful men.
The study also recorded some regional differences in suppression, with a higher proportion of suppressed patients in Nairobi and Central compared to Eastern and Western Kenya. The study also indicates long delays, of up to three weeks before test results are returned to the sampling facility. Because of these delays, many patients are shown to be lost to treatment.
Dr Mwau says with improvements the current systems can achieve a 10 day turnaround time.
“Ideally is to have a point-of-care VL testing, which would deliver results within hours.” Currently, most of the tests - 80 per cent - are done at Kemri. The other option is to have VL testing devolved to countries to hasten the process and reduce patient loss to treatment,” says Dr Mwau.
HIV treatment failure due to either drug resistance or non-adherence is a major concern. In April, Nascop, Kemri and the US Centre for Disease Control and Prevention reported that nearly one in four patients in Kenya failing second-line treatment has completely exhausted the available ARVs.