Technau Karl-Günter, Schomaker Michael, Kuhn Louise, Moultrie Harry, Coovadia Ashraf, Eley Brian, Rabie Helena, Wood Robin, Cox Vivian, Vizcaya Luisa Salazar, Muchiri Evans, Davies Mary-Ann
From the *Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand; †School of Public Health and Family Medicine, University of Cape Town, Cape Town; ‡Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; §Wits Reproductive Health and HIV Institute (Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Soweto), Faculty of Health Sciences, University of Witwatersrand, Johannesburg; ¶Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, The University of Cape Town, Cape Town; ‖Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch; **Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town; ††Médecins Sans Frontières South Africa and Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa; and ‡‡Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Pediatr Infect Dis J. 2014 Jun;33(6):617-22. doi: 10.1097/INF.0000000000000222.
Initiation criteria and pediatric antiretroviral treatment regimens have changed over the past few years in South Africa. We reported worse early virological outcomes associated with the use of abacavir (ABC)-based regimens at 1 large site: here, we expand this analysis to multiple sites in the IeDEA-Southern Africa collaboration.
Data for 9543 antiretroviral treatment-naïve children <16 years at treatment initiation started on either stavudine/lamivudine (d4T/3TC) or ABC/3TC with efavirenz (EFV) or ritonavir-boosted lopinavir (LPV/r) treated at 6 clinics in Johannesburg and Cape Town, South Africa, were analyzed with χ tests and logistic regression to evaluate viral suppression at 6 and 12 months.
Prevalence of viral suppression at 6 months in 2174 children started on a d4T-based LPV/r regimen was greater (70%) than among 438 children started on an ABC-based LPV/r regimen (54%, P < 0.0001). Among 3189 children started on a d4T-based EFV regimen, a higher proportion (86%) achieved suppression at 6 months compared with 391 children started on ABC-containing EFV regimens (78%, P < 0.0001). Relative benefit of d4T versus ABC on 6-month suppression remained in multivariate analysis after adjustment for pretreatment characteristics, cohort and year of program [LPV/r: odds ratio = 0.57 (confidence interval: 0.46-0.72); EFV: odds ratio = 0.46 (confidence interval: 0.32-0.65)].
This expanded analysis is consistent with our previous report of worse virological outcomes after ABC was introduced as part of first-line antiretroviral treatment in South Africa. Whether due to the drug itself or coincident with other changes over time, continued monitoring and analyses must clarify causes and prevent suboptimal long-term outcomes.
在过去几年中，南非的抗逆转录病毒治疗起始标准和儿科抗逆转录病毒治疗方案发生了变化。我们在1个大型医疗点报告了与使用基于阿巴卡韦（ABC）的治疗方案相关的较差早期病毒学结果：在此，我们将该分析扩展到国际流行病学数据库中南部非洲协作组（IeDEA-Southern Africa）的多个医疗点。
对南非约翰内斯堡和开普敦6家诊所开始接受抗逆转录病毒治疗的9543名初治儿童（年龄<16岁）的数据进行分析，这些儿童开始使用司他夫定/拉米夫定（d4T/3TC）或ABC/3TC联合依非韦伦（EFV）或利托那韦增强的洛匹那韦（LPV/r）治疗，采用χ检验和逻辑回归来评估6个月和12个月时的病毒抑制情况。
开始使用基于d4T的LPV/r治疗方案的2174名儿童在6个月时的病毒抑制率（70%）高于开始使用基于ABC的LPV/r治疗方案的438名儿童（54%，P<0.0001）。在开始使用基于d4T的EFV治疗方案的3189名儿童中，6个月时实现病毒抑制的比例（86%）高于开始使用含ABC的EFV治疗方案的391名儿童（78%，P<0.0001）。在对治疗前特征、队列和项目年份进行调整后的多变量分析中，d4T相对于ABC在6个月病毒抑制方面的相对益处仍然存在[LPV/r：比值比=0.57（置信区间：0.46-0.72）；EFV：比值比=0.46（置信区间：0.32-0.65）]。
这项扩展分析与我们之前的报告一致，即在南非将ABC作为一线抗逆转录病毒治疗的一部分引入后，病毒学结果较差。无论是由于药物本身还是随着时间推移与其他变化同时发生，持续监测和分析必须阐明原因并防止出现不理想的长期结果。
