Kirk Brianna L, Gomila Andres, Matshaba Mogomotsi, Marape Marape, Joel Dipesalema R, Anabwani Gabriel, Tolle Michael A
Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
J Int Assoc Provid AIDS Care. 2013 Mar-Apr;12(2):90-4. doi: 10.1177/1545109712463073. Epub 2013 Jan 11.
Data on the use of ritonavir-boosted darunavir (DRV/r) and/or raltegravir (RAL) in resource-limited settings are rare and there is currently no published data regarding their use among African children. Botswana has recently made DRV/r and RAL available for patients failing second-line antiretroviral therapy (ART).
Retrospective chart review of 4 multidrug-resistant pediatric patients on DRV/r- and/or RAL-based regimens. Viral load, CD4 count, adherence by pill count, and World Health Organization (WHO) clinical stage prior to and after switch to DRV/r- and/or RAL-based regimen were assessed. Antiretroviral therapy history, duration of virologic failure, and time to viral suppression were also noted. Genotypic resistance assays reviewed for mutations present prior to switch.
All patients achieved viral suppression, showed improved/stable CD4 counts, and obtained or maintained WHO clinical treatment stage I, even after long-standing virologic/immunologic failure.
Well tolerated by and effective in our patients, DRV/r and RAL provide potentially lifesaving ART options for children and adolescents in resource-limited settings failing ART due to ritonavir-boosted lopinavir (LPV/r) resistance.
在资源有限的环境中，关于使用利托那韦增强型达芦那韦（DRV/r）和/或拉替拉韦（RAL）的数据很少，目前尚无关于其在非洲儿童中使用情况的公开数据。博茨瓦纳最近已将DRV/r和RAL提供给二线抗逆转录病毒疗法（ART）治疗失败的患者。
对4例接受基于DRV/r和/或RAL方案治疗的耐多药儿科患者进行回顾性病历审查。评估了转换为基于DRV/r和/或RAL方案之前和之后的病毒载量、CD4细胞计数、通过药丸计数评估的依从性以及世界卫生组织（WHO）临床分期。还记录了抗逆转录病毒治疗史、病毒学失败持续时间和病毒抑制时间。审查基因分型耐药性检测，以了解转换前存在的突变。
所有患者均实现了病毒抑制，CD4细胞计数有所改善/保持稳定，即使在长期病毒学/免疫学失败后，也达到或维持了WHO临床治疗I期。
DRV/r和RAL在我们的患者中耐受性良好且有效，为因对利托那韦增强型洛匹那韦（LPV/r）耐药而在资源有限环境中接受ART治疗失败的儿童和青少年提供了可能挽救生命的ART选择。
