Nuttall J, Pillay V
Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
S Afr Med J. 2018 Feb 1;108(2):105-110. doi: 10.7196/SAMJ.2017.v108i2.12573.
There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatment-experienced children from resource-constrained settings receiving these drugs as part of routine care.
To describe the characteristics and early outcomes of treatment-experienced children (<20 years of age) in the Western Cape Province of South Africa treated with DRV/r-, RAL- or ETR-containing regimens.
This was a retrospective review of treatment-experienced children receiving a DRV/r-, RAL- or ETR-containing regimen as recommended by a paediatric expert review committee, based on HIV drug resistance testing.
Thirty-five children of median age 8.8 years (interquartile range (IQR) 5.5 - 11) who had received ART for a median of 6.9 years (IQR 5 - 9.9) and started a DRV/r-, RAL- or ETR-containing regimen were included. Before starting such a regimen, the median CD4+ lymphocyte count and HIV-1 RNA level were 405.5 cells/μL (IQR 251.5 - 541) and 28 314 copies/mL (IQR 5 595.5 - 120 186.5) (log 4.5 (IQR 3.7 - 5)), respectively, in 24 subjects with available results. After a median of 2 years (IQR 1.3 - 4) on treatment, 29/30 (96.7%) and 23/30 (76.7%) subjects with available results had HIV-1 RNA levels of <400 and <50 copies/mL, respectively.
This study found DRV/r-, RAL- and ETR-containing regimens to be effective in a group of treatment-experienced children and adolescents with multidrug-resistant HIV. Although the treatment regimens in this study were individualised based on HIV genotyping results, further research evaluating the safety and efficacy of standardised third-line treatment regimens in children of all ages is needed.
对于抗逆转录病毒治疗（ART）失败的HIV感染儿童，对三线治疗方案的需求日益增加。在资源有限环境中接受这些药物作为常规治疗一部分的有治疗经验的儿童中，关于含达芦那韦/利托那韦（DRV/r）、拉替拉韦（RAL）和依曲韦林（ETR）方案的数据有限。
描述在南非西开普省接受含DRV/r、RAL或ETR方案治疗的有治疗经验的儿童（<20岁）的特征和早期结局。
这是一项对有治疗经验的儿童的回顾性研究，这些儿童根据儿科专家审查委员会的建议，基于HIV耐药性检测接受含DRV/r、RAL或ETR的方案。
纳入了35名儿童，中位年龄8.8岁（四分位间距（IQR）5.5 - 11岁），接受ART的中位时间为6.9年（IQR 5 - 9.9年），并开始含DRV/r、RAL或ETR的方案。在开始此类方案之前，24名有可用结果的受试者的CD4 +淋巴细胞计数中位数和HIV-1 RNA水平分别为405.5个细胞/μL（IQR 251.5 - 541）和28314拷贝/mL（IQR 5595.5 - 120186.5）（对数4.5（IQR 3.7 - 5））。治疗中位时间为2年（IQR 1.3 - 4）后，29/30（96.7%）和23/30（76.7%）有可用结果的受试者的HIV-1 RNA水平分别<400和<50拷贝/mL。
本研究发现含DRV/r、RAL和ETR的方案对一组有治疗经验的多药耐药HIV儿童和青少年有效。尽管本研究中的治疗方案是根据HIV基因分型结果个体化的，但仍需要进一步研究评估标准化三线治疗方案对所有年龄段儿童的安全性和疗效。
