目标病毒载量检测在免疫失败的抗逆转录病毒治疗儿童中诊断病毒学失败中的作用。
The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.
机构信息
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital and University of Witwatersrand, Johannesburg, South Africa Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa Wits Reproductive Health and HIV Institute (Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Soweto), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa Médecins Sans Frontières South Africa and Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa Sinikithemba Clinic, McCord Hospital, Durban, South Africa Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
出版信息
Trop Med Int Health. 2012 Nov;17(11):1386-90. doi: 10.1111/j.1365-3156.2012.03073.x. Epub 2012 Sep 14.
OBJECTIVES
To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure.
METHODS
Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV-RNA monitoring are performed 6-monthly. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months.
RESULTS
Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%.
CONCLUSION
The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children.
目的
确定在对接受抗逆转录病毒治疗（ART）的 HIV 感染儿童进行单次靶向病毒载量检测时，免疫失败标准对识别病毒学失败的阳性预测值的改善，这些儿童被认为存在免疫失败。
方法
分析南非 ART 点的数据，这些 ART 点定期进行 CD4 计数/百分比和 HIV-RNA 监测。免疫失败根据世卫组织 2010 年和美国卫生与公众服务部（DHHS）2008 年标准进行定义。确证的病毒学失败定义为在接受 ART≥18 个月的儿童中，两次连续间隔<365 天的 HIV-RNA>5000 拷贝/ml。
结果
在接受 ART≥18 个月的 2798 名儿童中[ART 开始时的中位（IQR）年龄为 50（21-84）个月]，在 ART 后 42 个月时确证病毒学失败的累积概率为 6.3%。在符合 DHHS 免疫失败标准后进行靶向病毒载量检测而不是仅符合 DHHS 免疫失败标准，可将阳性预测值从 28%提高到 82%。靶向病毒载量将 WHO 2010 标准用于识别确证病毒学失败的阳性预测值从 49%提高到 82%。
结论
在免疫失败的儿童中增加单次病毒载量检测，将防止大多数病毒学抑制的儿童转为二线治疗。
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