{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:44:05Z","timestamp":1787798645272,"version":"build-2784847793"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T00:00:00Z","timestamp":1631232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Virological failure is under-recognized issue among children living with human immunodeficiency virus in developing countries. This partly may lead to failure to achieve the global goal of 90-90-90 targets in most developing countries including Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>This study aimed to assess the virological failure and its predictors among children receiving antiretroviral therapy at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An institutional based cross-sectional study was conducted among 253 study cohorts from January 2020-April 2021. Socio-demographic characteristics were collected using a structured questionnaire via a face-to-face interview, while detailed clinical data of the children were collected by reviewing the medical record. About 5 ml of blood were collected for the analysis of complete blood count and viral load quantification. Data were analyzed using SPSS version 20 and variables at p-value &lt; 0.05 in the multivariable analysis were considered as statistically significant.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>In this study, the viral load suppression rate among antiretroviral therapy experienced children was 68.8%. Meanwhile, the overall virological failure among study participants was 19.4%. Children living without family (AOR = 3.63; 95%CI: 1.27\u201310.24), children with unemployed family (AOR = 4.95; 95%CI: 1.74\u201314.12), being wasted (AOR = 3.02; 95%CI: 1.19\u20137.67) being stunted (AOR = 2.38;95%CI:1.03\u20135.46), anemia (AOR = 5.50:95%CI;1.37\u201322.04) and being lymphopenic (AOR = 2.69:95%CI;1.04\u20137.75) were significantly associated with virological failure among children under treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Higher virological failure among children was noteworthy in the present study. Caretakers other than immediate family, unemployed family, wasted, stunted, anemia, and lymphopenia were significant independent predictors of virological failure. Hence, standard, and optimal management of children under treatment should be warranted.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0257204","type":"journal-article","created":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T17:48:52Z","timestamp":1631296132000},"page":"e0257204","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Virological failure and associated factors among children receiving\u00a0anti-retroviral therapy, Northwest Ethiopia"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5703-0265","authenticated-orcid":true,"given":"Biruk","family":"Bayleyegn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemene Demelash","family":"Kifle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demeke","family":"Geremew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,10]]},"reference":[{"issue":"Suppl 2","key":"pone.0257204.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S2055-6640(20)30340-X","article-title":"Treating all people living with HIV in sub-Saharan Africa: a new era calling for new approaches","volume":"4","author":"D. Nash","year":"2018","journal-title":"Journal of virus eradication"},{"key":"pone.0257204.ref002","unstructured":"FMOH, National consolidated guidelines for comprehensive HIV prevention, care and treatmen. 2018. Available at:https:\/\/www.afro.who.int\/sites\/default\/files\/2019-04\/National%20Comprehensive%20HIV%20Care%20%20Guideline%202018.pdf."},{"issue":"9777","key":"pone.0257204.ref003","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/S0140-6736(11)60208-0","article-title":"Risk of triple-class virological failure in children with HIV: a retrospective cohort study","volume":"377","author":"PLATO","year":"2011","journal-title":"The Lancet"},{"issue":"3","key":"pone.0257204.ref004","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1086\/380793","article-title":"CD38 expression in CD8+ T cells predicts virological failure in HIV type 1\u2013infected children receiving antiretroviral therapy","volume":"38","author":"S. Resino","year":"2004","journal-title":"Clinical infectious diseases"},{"key":"pone.0257204.ref005","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ijid.2018.10.019","article-title":"Patterns of detectable viraemia among children and adults with HIV infection taking antiretroviral therapy in Zimbabwe","volume":"78","author":"E. Sovershaeva","year":"2019","journal-title":"International Journal of Infectious Diseases"},{"issue":"Supplement_1","key":"pone.0257204.ref006","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1086\/650383","article-title":"Challenges in implenting HIV load testing in South Africa","volume":"201","author":"W.S. Stevens","year":"2010","journal-title":"Journal of Infectious Diseases"},{"issue":"1","key":"pone.0257204.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1742-6405-8-40","article-title":"Immunologic and virologic failure after first-line NNRTI-based antiretroviral therapy in Thai HIV-infected children","volume":"8","author":"T. Bunupuradah","year":"2011","journal-title":"AIDS research and therapy"},{"issue":"1","key":"pone.0257204.ref008","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/s12879-019-3781-1","article-title":"A superiority of viral load over CD4 cell count when predicting mortality in HIV patients on therapy","volume":"19","author":"C. Shoko","year":"2019","journal-title":"BMC infectious diseases"},{"issue":"1","key":"pone.0257204.ref009","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s12985-017-0893-3","article-title":"A cheap and open HIV viral load technique applicable in routine analysis in a resource limited setting with a wide HIV genetic diversity","volume":"14","author":"E.T. Ngo-Malabo","year":"2017","journal-title":"Virology journal"},{"key":"pone.0257204.ref010","unstructured":"WHO, What\u2019s new in treatment monitoring: Viral load and CD4 testing.HIV treatment and care. Updated 2017. Available at: https:\/\/www.who.int\/hiv\/pub\/arv\/treatment-monitoring-info-2017\/en\/. Accessed date 01\/7\/2021"},{"issue":"2","key":"pone.0257204.ref011","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/QAI.0b013e31814278c0","article-title":"Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy","volume":"46","author":"M.R. Kamya","year":"2007","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"issue":"9","key":"pone.0257204.ref012","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1093\/jac\/dkx188","article-title":"Pretreatment HIV drug resistance results in virological failure and accumulation of additional resistance mutations in Ugandan children","volume":"72","author":"C. Kityo","year":"2017","journal-title":"Journal of Antimicrobial Chemotherapy"},{"issue":"11","key":"pone.0257204.ref013","doi-asserted-by":"crossref","first-page":"e0200242","DOI":"10.1371\/journal.pone.0200242","article-title":"Adoption of routine virologic testing and predictors of virologic failure among HIV-infected children on antiretroviral treatment in western Kenya","volume":"13","author":"J. Kadima","year":"2018","journal-title":"PloS one"},{"issue":"12","key":"pone.0257204.ref014","doi-asserted-by":"crossref","first-page":"3471","DOI":"10.1093\/jac\/dky348","article-title":"High prevalence of virological failure and HIV drug mutations in a first-line cohort of Malawian children","volume":"73","author":"M.H. Huibers","year":"2018","journal-title":"Journal of Antimicrobial Chemotherapy"},{"key":"pone.0257204.ref015","unstructured":"FHAPCO, HIV Prevention in Ethiopia National Road Map 2018\u20132020. 2018."},{"issue":"1","key":"pone.0257204.ref016","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12889-020-8160-8","article-title":"HIV\/AIDS treatment failure and associated factors in Ethiopia: meta-analysis","volume":"20","author":"A. Endalamaw","year":"2020","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0257204.ref017","doi-asserted-by":"crossref","first-page":"e0215300","DOI":"10.1371\/journal.pone.0215300","article-title":"Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study","volume":"14","author":"B.A. Yihun","year":"2019","journal-title":"PloS one"},{"issue":"1","key":"pone.0257204.ref018","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1186\/s12879-019-4058-4","article-title":"Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia","volume":"19","author":"M.B. Shiferaw","year":"2019","journal-title":"BMC infectious diseases"},{"issue":"1","key":"pone.0257204.ref019","doi-asserted-by":"crossref","DOI":"10.2174\/1874613602014010061","article-title":"Virological Failure and Associated Risk Factors among HIV\/AIDS Pediatric Patients at the ART Clinic of Jimma university Medical Center, Southwest Ethiopia","volume":"14","author":"F.T. Osman","year":"2020","journal-title":"The Open AIDS Journal"},{"issue":"1","key":"pone.0257204.ref020","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12887-019-1402-1","article-title":"Predictors of treatment failure, time to switch and reasons for switching to second line antiretroviral therapy in HIV infected children receiving first line anti-retroviral therapy at a Tertiary Care Hospital in Ethiopia","volume":"19","author":"G.S. Haile","year":"2019","journal-title":"BMC pediatrics"},{"key":"pone.0257204.ref021","unstructured":"WHO, Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. 2021."},{"key":"pone.0257204.ref022","first-page":"19005538","article-title":"Rate and predictors of Treatment Failure among pediatric population taking Highly Active Antiretroviral Therapy in Ethiopia","author":"Y.G. Misganie","year":"2019","journal-title":"medRxiv"},{"key":"pone.0257204.ref023","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/1346104","article-title":"Prevalence and risk factors of active TB among adult HIV patients receiving ART in northwestern Tanzania: a retrospective cohort study","volume":"2018","author":"D.W. Gunda","year":"2018","journal-title":"Canadian Journal of Infectious Diseases and Medical Microbiology"},{"issue":"3","key":"pone.0257204.ref024","doi-asserted-by":"crossref","first-page":"e0247878","DOI":"10.1371\/journal.pone.0247878","article-title":"Magnitude and associated factors of peripheral cytopenia among HIV-infected children attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia","volume":"16","author":"B. Bayleyegn","year":"2021","journal-title":"PloS one"},{"key":"pone.0257204.ref025","volume-title":"VMNIS | Vitamin and Mineral Nutrition Information System","author":"WHO","year":"2011"},{"issue":"3","key":"pone.0257204.ref026","volume":"5","author":"S. Roy Chowdhury","year":"2016","journal-title":"Factors Influencing Adherence to Antiretroviral Therapy In Pediatric HIV"},{"key":"pone.0257204.ref027","first-page":"229","article-title":"Antiretroviral Treatment Failure and Associated Factors Among HIV-Infected Children on Antiretroviral Therapy: A Retrospective Study","volume":"13","author":"S. Getawa","year":"2021","journal-title":"HIV\/AIDS (Auckland, NZ)"},{"issue":"1","key":"pone.0257204.ref028","article-title":"Virologic Failure and its Determinant Factors among Children in First Line on Highly Active Anti Retroviral Therapy at Felegehiwot Referral Hospital, Bahir Dar, Northwest, Ethiopia: cross-sectional study","volume":"3","author":"GB, N.E Brhane","year":"2020","journal-title":"Adv Hema Onco Res"},{"key":"pone.0257204.ref029","volume-title":"Guideline: updates on the management of severe acute malnutrition in infants and children","author":"WHO","year":"2013"},{"issue":"1","key":"pone.0257204.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13052-021-01030-7","article-title":"Magnitude and associated factors of virological failure among children on ART in Bahir Dar Town public health facilities, Northwest Ethiopia: a facility based cross-sectional study","volume":"47","author":"B. Gelaw","year":"2021","journal-title":"Italian Journal of Pediatrics"},{"issue":"1","key":"pone.0257204.ref031","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/INF.0000000000002898","article-title":"Predictors of Virologic Failure Among a Cohort of HIV-infected Children in Southern Ethiopia","volume":"40","author":"B.T. Tadesse","year":"2020","journal-title":"The Pediatric Infectious Disease Journal"},{"issue":"23","key":"pone.0257204.ref032","article-title":"S Long-term virological outcome in children receiving first-line antiretroviral therapy","volume":"15","author":"P, S.A Chandrasekaran","year":"2018","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pone.0257204.ref033","first-page":"1","article-title":"High level of treatment failure and drug resistance to first-line antiretroviral therapies among HIV-infected children receiving decentralized care in Senegal","volume":"19","author":"A.-M. Ciss\u00e9","year":"2019","journal-title":"BMC pediatrics"},{"issue":"Suppl 2","key":"pone.0257204.ref034","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000260.20","article-title":"Prevalence and risk factors of virological failure among children on antiretroviral therapy","volume":"2","author":"M. Owusu","year":"2017","journal-title":"BMJ Global Health"},{"issue":"3","key":"pone.0257204.ref035","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/QAI.0b013e3182060610","article-title":"Virologic failure and second-line antiretroviral therapy in children in South Africa-The IeDEA Southern Africa Collaboration","volume":"56","author":"M.-A. Davies","year":"2011","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"key":"pone.0257204.ref036","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.2147\/IDR.S251619","article-title":"Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study","volume":"13","author":"H. Negash","year":"2020","journal-title":"Infection and Drug Resistance"},{"key":"pone.0257204.ref037","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/7360190","article-title":"Assessment of Prevalence of Malnutrition and Its Associated Factors among AIDS Patients from Asella, Oromia, Ethiopia","volume":"2020","author":"T. Teklu","year":"2020","journal-title":"BioMed Research International"},{"issue":"1","key":"pone.0257204.ref038","first-page":"1","article-title":"Anaemia in HIV-infected children: severity, types and effect on response to HAART","volume":"12","author":"E.N. Ruhinda","year":"2012","journal-title":"BMC pediatrics"},{"issue":"2","key":"pone.0257204.ref039","first-page":"152","article-title":"Impact of anemia on outcome of HIV-infected pediatric patients: A prospective observational study. Indian journal of community medicine: official publication of Indian Association of Preventive &","volume":"44","author":"B.B. Bhaisara","year":"2019","journal-title":"Social Medicine"},{"key":"pone.0257204.ref040","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/9643901","article-title":"Magnitude of Anemia and Associated Factors among HIV-Infected Children Receiving Antiretroviral Therapy in Pastoral Community, Ethiopia: A Retrospective Cross-Sectional Study","volume":"2020","author":"G. Fentaw Mulaw","year":"2020","journal-title":"Advances in Hematology"},{"issue":"1","key":"pone.0257204.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2334-12-128","article-title":"Total lymphocyte count as a surrogate marker for CD4 count in resource-limited settings","volume":"12","author":"C. Obirikorang","year":"2012","journal-title":"BMC Infectious Diseases"},{"key":"pone.0257204.ref042","first-page":"145","article-title":"Correlation of CD4 with total lymphocyte counts in HIV patients","author":"R. Riyanti","year":"2017","journal-title":"UNEJ e-Proceeding"},{"key":"pone.0257204.ref043","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/7907352","article-title":"Body mass index, haemoglobin, and total lymphocyte count as a surrogate for CD4 count in resource limited settings","volume":"2017","author":"L.B. Kwantwi","year":"2017","journal-title":"Journal of biomarkers"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257204","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T17:49:33Z","timestamp":1631296173000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257204"}},"subtitle":[],"editor":[{"given":"Brian C.","family":"Zanoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,10]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0257204","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,10]]}}}