Adherence to antiretroviral therapy and drug resistance impact evolving viral suppression among a cohort of children and adolescents living with perinatal HIV infection in western Kenya
7 affiliations
- 1Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- 2Arnhold Institute for Global Health, New York, New York, United States of America
- 3Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- 4Moi University, Eldoret, Kenya
- 5Brown University School of Public Health, Providence, Rhode Island, United States of America
- 6Global Health Program, College of Liberal Arts and Sciences, DePauw University, Greencastle, Indiana, United States of America
- 7Brown University Alpert Medical School, Providence, Rhode Island, United States of America
Abstract
Background: We characterize antiretroviral therapy (ART) adherence among children and adolescents living with perinatal HIV (CALWH) and investigate its impact on treatment failure (TF) and drug resistance (DR). Methods: We enrolled Kenyan CALWH ≤15 years on NNRTI-based ART and monitored adherence over six months, with monthly, validated questionnaires and continuous MEMs (Medication Event Monitoring Systems) electronic dose monitoring. We assessed associations between TF (viral load (VL) >1,000 copies/mL; local guidelines) at 1 month (Blood Draw 1, BD1) and, for a subset, at 4 months (Blood Draw 2, BD2) and adherence using weighted logistic regression. Sanger genotyping identified reverse transcriptase DR mutations upon TF. Associations between number of mutations and adherence was modelled by weighted Poisson regression. Results: Among 692 CALWH (51% female; mean 8.4 years) on ART for mean 2.6 years between 2010−2013, 44% reported non-adherence at baseline. At BD1, 21% (N = 143/464) had TF. Reported non-adherence at enrollment and lower MEMS adherence between enrollment and BD1 were significantly associated with TF at BD1 (respectively, OR=1.25 per 1 unit higher non-adherence, 95% CI = 1.05 to 1.48, and OR=0.69 per 1 unit z-score higher MEMS adherence, 95% CI = 0.50 to 0.95). Among those with TF at BD1, 43% (31/72) had TF at BD2, higher MEMS adherence no longer predicted VL suppression. DR genotyping among those with TF at BD1 found fewer mutations for those without treatment interruption >48 hours (RR = 0.17, CI = 0.05 to 0.61), but among them, more mutations for those with longer interruptions (hours, log-10 RR = 2.48, CI = 1.10 to 5.59). More resistance was also associated with longer ART years (Log-10 RR = 1.47, CI = 1.15 to 1.89), and higher log-10 VL at BD1 (RR = 1.21, CI = 1.06 to 1.37)). MEMS adherence had significant, U-shaped relationship, with most mutations at lower (<50%) adherence. Conclusion: Well characterized non-adherence among Kenyan CALWH was common and resulted in increased risks for TF and extensive DR, highlighting treatment challenges.
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BibTeX
@article{vreeman2026adherence,
title = {{Adherence to antiretroviral therapy and drug resistance impact evolving viral suppression among a cohort of children and adolescents living with perinatal HIV infection in western Kenya}},
author = {Rachel Vreeman and Winstone Nyandiko and Allison DeLong and Ashley Chory and Michael Scanlon and Josephine Aluoch and Edwin Sang and Vladimir Novitsky and Festus Sang and Celestine Ashimosi and Samuel Ayaya and Eslyne Jepkemboi and Millicent Orido and Joseph Hogan and Rami Kantor},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0355492},
url = {https://doi.org/10.1371/journal.pone.0355492},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adherence to antiretroviral therapy and drug resistance impact evolving viral suppression among a cohort of children and adolescents living with perinatal HIV infection in western Kenya
AU - Rachel Vreeman
AU - Winstone Nyandiko
AU - Allison DeLong
AU - Ashley Chory
AU - Michael Scanlon
AU - Josephine Aluoch
AU - Edwin Sang
AU - Vladimir Novitsky
AU - Festus Sang
AU - Celestine Ashimosi
AU - Samuel Ayaya
AU - Eslyne Jepkemboi
AU - Millicent Orido
AU - Joseph Hogan
AU - Rami Kantor
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0355492
UR - https://doi.org/10.1371/journal.pone.0355492
AB - Background: We characterize antiretroviral therapy (ART) adherence among children and adolescents living with perinatal HIV (CALWH) and investigate its impact on treatment failure (TF) and drug resistance (DR). Methods: We enrolled Kenyan CALWH ≤15 years on NNRTI-based ART and monitored adherence over six months, with monthly, validated questionnaires and continuous MEMs (Medication Event Monitoring Systems) electronic dose monitoring. We assessed associations between TF (viral load (VL) >1,000 copies/mL; local guidelines) at 1 month (Blood Draw 1, BD1) and, for a subset, at 4 months (Blood Draw 2, BD2) and adherence using weighted logistic regression. Sanger genotyping identified reverse transcriptase DR mutations upon TF. Associations between number of mutations and adherence was modelled by weighted Poisson regression. Results: Among 692 CALWH (51% female; mean 8.4 years) on ART for mean 2.6 years between 2010−2013, 44% reported non-adherence at baseline. At BD1, 21% (N = 143/464) had TF. Reported non-adherence at enrollment and lower MEMS adherence between enrollment and BD1 were significantly associated with TF at BD1 (respectively, OR=1.25 per 1 unit higher non-adherence, 95% CI = 1.05 to 1.48, and OR=0.69 per 1 unit z-score higher MEMS adherence, 95% CI = 0.50 to 0.95). Among those with TF at BD1, 43% (31/72) had TF at BD2, higher MEMS adherence no longer predicted VL suppression. DR genotyping among those with TF at BD1 found fewer mutations for those without treatment interruption >48 hours (RR = 0.17, CI = 0.05 to 0.61), but among them, more mutations for those with longer interruptions (hours, log-10 RR = 2.48, CI = 1.10 to 5.59). More resistance was also associated with longer ART years (Log-10 RR = 1.47, CI = 1.15 to 1.89), and higher log-10 VL at BD1 (RR = 1.21, CI = 1.06 to 1.37)). MEMS adherence had significant, U-shaped relationship, with most mutations at lower (<50%) adherence. Conclusion: Well characterized non-adherence among Kenyan CALWH was common and resulted in increased risks for TF and extensive DR, highlighting treatment challenges.
SN - 1932-6203
ER -