Department of Viral Infection and International Health, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Ishikawa, Kanazawa 920-8640, Japan.
J Clin Virol. 2011 Oct;52(2):123-8. doi: 10.1016/j.jcv.2011.06.014. Epub 2011 Jul 27.
Worldwide access to antiretroviral therapy (ART) in low- and middle-income countries has significantly increased. Although this presents better treatment options for HIV-infected individuals, the challenge of monitoring ART in these settings still remains.
To investigate efficient and cost-effective criteria for assessing ART failure among HIV-1-infected children on first-line ART in resource-limited settings.
Retrospective analysis of 75 HIV-1 vertically infected Kenyan children with a follow-up period of 24 months after initiating ART. Plasma viral load, peripheral CD4(+)T-cell counts and HIV-1 drug-resistance mutations were monitored biannually.
Plasma viral load (VL) was suppressed to undetectable level or more than 1.5 log(10) from baseline levels in 53 (70.7%) children within 24 months. VL in the remaining 22 (29.3%) children was not suppressed significantly. Of the 22 children, 21 were infected with HIV-1 strains that developed drug-resistance mutations; 9 within 12 months and 12 between 12 and 24 months. Among the 53 who were successfully treated, VL was suppressed in 33 within 12 months and in 20 between 12 and 24 months. There was no significant difference in VL at baseline and the change of CD4(+)T-cell counts after initiating ART between those treated successfully and the failure groups.
After initiating ART, children may require longer times to achieve complete viral suppression. Plasma viral load testing 24 months after initiating ART could be used to differentiate ART failures among HIV-1 vertically infected children in resource-limited settings. Additionally, drug resistance testing, if affordable, would be helpful in identifying those failing therapy and in choosing second-line regimens.
在中低收入国家，抗逆转录病毒疗法（ART）的普及程度显著提高。尽管这为感染艾滋病毒的个体提供了更好的治疗选择，但在这些环境中监测 ART 的挑战仍然存在。
在资源有限的环境中，研究用于评估接受一线 ART 的 HIV-1 感染儿童发生 ART 失败的高效且具有成本效益的标准。
对在开始 ART 后随访 24 个月的 75 例肯尼亚 HIV-1 垂直感染儿童进行回顾性分析。每 6 个月监测一次血浆病毒载量、外周血 CD4+T 细胞计数和 HIV-1 耐药突变。
在 24 个月内，53 例（70.7%）儿童的血浆病毒载量（VL）从基线水平降至不可检测水平或下降超过 1.5log10。其余 22 例（29.3%）儿童的 VL 未显著下降。在这 22 例儿童中，21 例感染的 HIV-1 株发生了耐药突变；9 例在 12 个月内，12 例在 12 至 24 个月内。在 53 例成功治疗的儿童中，33 例在 12 个月内，20 例在 12 至 24 个月内 VL 得到抑制。成功治疗组和失败组在开始 ART 时的 VL 及开始 ART 后 CD4+T 细胞计数的变化无显著差异。
在开始 ART 后，儿童可能需要更长的时间才能完全抑制病毒。在开始 ART 后 24 个月进行血浆病毒载量检测可用于区分资源有限环境中 HIV-1 垂直感染儿童的 ART 失败。此外，如果负担得起，耐药性检测有助于识别那些治疗失败的患者，并选择二线治疗方案。
